Cluster Headaches

The cause of cluster headaches is unknown. Experts believe that they begin in the part of the brain that manages daily changes in the function of body organs.

Cluster headaches usually last less than 1 hour and rarely longer than 4 hours. The pain is usually sudden and severe and may feel like a stabbing sensation on one side of the head. An individual may feel pain in one eye. The eye may swell and turn red. Someone with a cluster headache usually moves around trying to find a position to ease the pain. Some people even rock back and forth seeking relief or distraction.

Some additional symptoms of cluster headaches include:

• flushing of the face
• pain that spreads to the face and neck
• runny nose or nasal congestion
• tearing from the eyes

The causes and risks of cluster headaches are unknown. Cluster headaches occur most often in men between the ages of 20 and 40. Smoking and alcohol use can trigger a cluster headache. Some cluster headaches may be triggered by nasal congestion.

In general, cluster headaches cannot be prevented. Someone who smokes should quit smoking, and those who drink alcohol should limit their intake. Treatment of nasal congestion may eliminate some headache triggers.

Diagnosis of a cluster headache begins with a medical history and physical exam. The healthcare provider may order tests such as head CT or magnetic resonance (MRI) scans to rule out other causes of the headaches.

Cluster headaches have no significant long-term effects.

Cluster headaches are not contagious and pose no risk to others.

Some cluster headaches improve when the person inhales oxygen for a short period of time. The healthcare provider may also prescribe preventive medications to keep cluster headaches from starting, or other medications to treat a cluster headache once it develops.

Preventive medications or procedures include the following:

• calcium channel blockers, such as verapamil (i.e., Calan, Covera, Isoptin, Verelan) or nifedipine (i.e., Adalat, Procardia)
• nimodipine (i.e., Nimotop)
• corticosteroids, such as prednisone
• lithium (i.e., Eskalith, Lithobid)
• methysergide (i.e., Sansert)
• indomethacin (i.e., Indocin)
• a procedure called histamine desensitization is done at some major headache centers.

Following are some of the medications or treatments that can be used during a cluster headache:

• dihydroergotamine (i.e., DHE 45), which is inhaled as a spray up the nose
• ergotamine (i.e., Cafergot), which may be inhaled, injected, or inserted rectally
• a local anesthetic (i.e., Lidocaine), which is inhaled up the nose
• sumatriptan (i.e., Imitrex), which can be given orally or injected intramuscularly.
• 100% oxygen at 7-10 liters for 10-15 minutes administered through a tight-fitting face mask while in a sitting position and breathing at a normal respiratory rate

Many of the medications used to treat cluster headaches cause an increase in blood pressure. Corticosteroids may cause increased risk of infection, osteoporosis, and bleeding. Lithium may cause increased thirst and urination. It may also cause nausea and trembling of the hands. Calcium channel blockers may significantly increase a person's risk for stroke and heart attack. Methysergide can cause a hardening of the lung tissue.

Preventive medications usually do a good job of reducing the number of cluster headaches. Medications given during the headache can reduce the pain and shorten the length of the headache.

Any new or worsening symptoms should be reported to the healthcare provider.