cluster headache

Cluster Headache 101: Causes, Symptoms, Treatment & Remedies

What is a cluster headache? Learn more about the causes, symptoms, triggers, remedies, treatment, and prevention of tension headaches.

by Grace Koh

What is a Cluster Headache?

A cluster headache is a type of headache that causes intense pain. It starts suddenly, usually on one side of the head, or around one eye. The headache reaches its peak in five to 10 minutes, and is described as a constant and deep, burning, and piercing type of pain. It is marked by several headaches repeatedly happening within the day, with durations ranging from 15 mins to 1.5 hours, and up to four times a day in some instances. They usually stop quickly, and are followed by headache-free periods, before the next headache starts again. It can cause tearing in the affected eye and a runny nose as well. Cluster headaches happen on a daily basis, across several weeks or months even. These headaches appear to be linked to the body clock, or also known as circadian rhythm. They happen at the same time each day on a regular basis, and have been nicknamed ‘alarm clock headaches’. 

Cluster headaches are relatively uncommon. They are more common in teens and middle aged individuals. In particular, males between the age of 25 to 45 years old are known to be more at risk for cluster headaches.

Cluster headaches can be classified into two types of headache: episodic and chronic

Episodic Cluster Headaches

Occur regularly between a week and a year. They are followed by a headache-free period of a month or more. 

Chronic Cluster Headaches

This classification of cluster headache occur regularly for longer than a year, and are followed by a headache-free period of less than a month. These two types of headaches can cross over; a  chronic cluster headache could develop into an episodic cluster headache and vice versa. 

Cluster Headache Symptoms

Cluster headache usually occurs on one side of the head. Besides this, symptoms of a cluster headache include: 

  • Droopy eyelid on the affected side of the face
  • Excessive tearing from the eye 
  • Change in pupil size to become smaller than usual
  • Eye redness
  • Sensitivity to light 
  • Swelling under or around one or both eyes 
  • Runny or blocked nose 
  • Facial redness or flushing 
  • Agitation or restlessness 
  • Nausea 
  • Sweating 

Cluster Headache Causes & Triggers

The cause of a cluster headache is believed to involve the part of the brain that controls our sleep and wake cycles amidst other important body functions, the hypothalamus. The hypothalamus sends a signal to the trigeminal nerve, which is the nerve pathway aiding in sensation in the face. The trigeminal nerve is near the eye, and it branches up to the forehead, across the cheek, down the jaw, and above the ear on one side of the face. This triggers the cluster headache.

Cluster headaches are also caused by the sudden releases of chemicals in the body called histamine, which help fight against allergens, and serotonin, which helps to regulate moods. 

During a period of cluster headaches, triggers of the headache include: 

  • Smoking 
  • Alcohol use
  • Strong smells

Cluster Headache vs Migraine

Cluster headache and migraines are both types of headaches, but with some key differences to distinguish between the two. Below are some signs to distinguish migraine from cluster headaches:

Place Where Headache Happens

For migraines, they occur only in a particular area of the head, such as on both sides, on one side, or along the forehead. A cluster headache usually affects one side of the face, and affects several parts of the side of the face. 

How It Starts

Migraines come on gradually, and become progressively more painful, before fading off. Cluster headaches normally come on suddenly, and are marked by a burst of intense pain as it starts. 

Stages of Headache Progression

A migraine is differentiated from a cluster headache by its progression. Migraine tends to progress through several stages, and can begin slowly and last across a few hours to a few days. It may be marked by warning signs a day before the pain starts, such as having cravings for certain foods, or mood changes. Some people experience seeing auras (coloured spots, lines, flashing lights, or sparkles in the vision) right before the migraine hits. 

Symptoms

Symptoms of migraine are numbness or tingling, weakness, trouble speaking or hearing, and tiredness and confusion after the migraine ends. However for cluster headaches, it affects the eyes, and include symptoms like teary eyes. Refer above for more symptoms of cluster headaches. 

Some of the below can trigger migraine, such as: 

  • Changes in weather
  • Too little or too much sleep
  • Strong smells (this is common with cluster headache) 
  • Stress
  • Loud noises
  • Eating too little
  • Anxiety or depression
  • Certain types of medication 
  • Changes in hormones
  • Caffeine and certain food additives

Cluster Headache Diagnosis

During the doctor’s visit, the doctor will collect information about symptoms and history of the cluster headache. Some of these questions could include: 

  • When did symptoms begin? 
  • Have these symptoms been occasional, or do they happen often?
  • Do the symptoms occur around the same time each day? 
  • Does consuming alcohol appear to trigger off the symptoms? 
  • How serious are the symptoms affecting the individual’s life? 
  • What, if anything, appears to improve the symptoms? 
  • What, if anything, appears to worsen the symptoms? 

The doctor will then conduct a physical examination as well as a neurological examination. This helps to check for disorders of the brain or spinal cord, and may involve tasks like testing motor reflexes or sensory functioning. Further tests like an MRI or CT scan of the brain may be done. This is to help rule out other possible causes of headache, such as a brain tumour. Some information about the tests are as below: 

  • MRI uses a powerful magnetic field and radio waves to produce detailed images of the brain and the blood vessels. 
  • CT scan uses a series of X-rays to create detailed images of the brain so the doctor can review the brain’s structures. 

Cluster Headache Treatment

There are several treatment options for cluster headaches, like taking medication or nerve stimulation. Medication can focus on reducing pain during acute attack, and also in preventing cluster headaches before they start.  If both nerve stimulation and medication do not help, surgery may be recommended. 

Pain medication 

These types of medication aids to relieve pain in the event of a cluster headache happening. Some types of medication which may be prescribed are: 

Triptan medications

Hailed as one of the best ways to relieve the pain, triptan medications work by constricting blood vessels, which help to ease the pain from the headache. Sumatriptan, a type of this class of medication, is taken through a nasal spray or through a shot. 

Oxygen

The doctor may recommend inhaling 100-percent pure oxygen when the headache begins. It is inhaled through a face mask for around 15 minutes, and can help to relieve symptoms. 

Octreotide

This is a type of growth hormone made in a laboratory. It is taken through an IV drip in the vein.

Local anaesthetics

Lidocaine, a type of pain reliever, is taken by spraying the drug into the nose with a nasal spray. 

DHE

DHE’s full name is dihydroergotamine, and it is injected into the body. It can relieve cluster headache pain within five minutes of use. It cannot be taken concurrently with sumatriptan (a type of triptan medication).

Alternative Remedies for Pain Relief

There are alternative or complementary therapies to help relieve the intense pain of a cluster headache. 

Melatonin

This medication, known for easing sleep problems like jet lag, could potentially help to lower the number of headaches.

Capsaicin

There is some evidence that this medication could reduce the frequency and severity of cluster headache attacks. It is used by applying it inside the nose. 

Preventive Medication

This type of medication prevents headaches from occurring. They stop the headache before it starts. They may not be 100-percent effective, but they are able to help reduce the number of times the cluster headache occurs. Such medication includes: 

Steroid medication

Corticosteroids, such as prednisone, help to reduce nerve inflammation, thereby reducing the frequency of headaches. 

Blood pressure medications

These include propranolol or verapamil. They help to relax the blood vessels. 

Ergotamine

This form of medication helps keep the blood vessels from dilating and becoming wider. 

Anti-seizure medications

Topiramate, lithium carbonate, and valproic acid are some of such medications. 

Antidepressant medications

These can help to prevent cluster headaches from occurring.

Muscle relaxants

Baclofen is one of the types of muscle relaxants given to individuals to prevent cluster headaches. 

Medication can be obtained through a doctor’s prescription.

Nerve Stimulation

When medication is not effective in managing the cluster headache, nerve stimulation may be recommended. Some success has been found with the following methods: 

Occipital nerve block

This is also known as occipital nerve injection. A mix of anaesthetic and steroid is injected into these nerves at the base of the skull, which is often the starting point for headaches. This is a temporary treatment until a preventive measure is found to work in the individual. It is often used with verapamil.

Neuromodulation

This form of treatment stimulates the nerves or neural tissue to change neural activity. It is emerging as a practical and safe alternative to conventional pharmacological interventions for the treatment of migraine and cluster headache. For example, a type of neuromodulation treatment involves placing electrodes on the forehead of the individual receiving treatment and sending electrical signals to the supraorbital nerve, which is the nerve above the eye. 

Surgery

Surgery is often the last resort, if the above treatment methods do not prove effective. 

Surgical procedures usually involve blocking the trigeminal nerve, which controls the area around the eye and other parts of the face. The trigeminal nerve is a main pathway for pain, hence this could help with relieving pain from cluster headache permanently. However, this surgery is risky as a wrong move could lead to permanent jaw weakness and loss of sensation in the face and head, leading to facial numbness. 

Deep brain stimulation is a surgical method which involves placing an electrode deep into the brain, and connecting these electrodes to a generator that helps change the brain’s electrical impulses and relieve pain. There are high risks to this method, such as infection or haemorrhage. Deep brain stimulation is a promising but unproven treatment method. It is used only if medication has not been successful. 

Cluster Headache Prevention

Cluster headaches are not life-threatening, but they definitely do have a huge impact on daily living when it strikes. There is presently no cure for cluster headaches. Below are some tips to prevent cluster headaches. Hopefully over time, the headaches become less frequent and less painful, and eventually disappear completely by themselves. 

  • Keep a regular sleep schedule, as a change to routine can trigger a headache. 
  • Avoid alcohol and tobacco, which are triggers for cluster headaches, can help to prevent starting a cluster headache.
  • Avoid foods with a high amount of nitrates, such as hot dogs, bacon, preserved and processed meats. 
  • Do not take hot baths.
  • Do not do strenuous activities.
  • Do avoid hot weather conditions if possible. 

When Should I See a Doctor for Cluster Headache?

Cluster headaches can severely affect a person’s daily life, and can be very stressful and frustrating to experience. If there are suspicions of a cluster headache, it is recommended to see a doctor to seek further treatment if needed. 

Before seeing the doctor, it could be helpful to note down some of the symptoms present. Keep a record of headaches experienced, and write down these details each time they occur to help the doctor determine the type of headache and find out possible headache triggers. 

  • Date and time can help to discover a pattern in which the headaches occur. 
  • Duration, how long does each headache last? 
  • Rate the headache on a pain scale of one to 10, with 10 being the most severe. 
  • Observe possible triggers whether the headache occurred after certain events, such as sounds, smells, certain foods, physical activity or oversleeping. 
  • Write down all medication consumed, even if unrelated to the headache. 
  • Take note of symptoms such as whether auras are experienced with the headache.
  • Has there been any pain relief, or none at all?

It’s always safe to not consider headaches as something ‘simple’ or ‘normal’. One should be more aware and sensitive to the symptoms and signals it give to know when to see a doctor.

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References
  1. Mayo Clinic. (2019, June 4). Cluster Headache  – Diagnosis and Treatment. Retrieved 26 June 2021, from https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084
  2. Healthhub. (n.d.). Headache and Migraine. Retrieved June 23, 2021, from https://www.healthhub.sg/a-z/diseases-and-conditions/649/headache-and-migraine
  3. Kivi, R. (2018, August 16). Cluster Headaches. Healthline. https://www.healthline.com/health/cluster-headache
  4. Lee, V., Ang, L., Soon, D., Ong, J., & Loh, V. (2018). The adult patient with headache. Singapore Medical Journal, 59(8), 399–406. https://doi.org/10.11622/smedj.2018094
  5. Reuter U, McClure C, Liebler E, et al. (2019). Non-invasive neuromodulation for migraine and cluster headache: a systematic review of clinical trials. J Neurol Neurosurg Psychiatry 2019;90:796–804. http://dx.doi.org/10.1136/jnnp-2018-320113
  6. WebMD. (2002, March 27). Cluster Headache – Symptoms, Causes, and Treatment. https://www.webmd.com/migraines-headaches/cluster-headaches
About the Writer
Grace Koh
Apart from reading, singing, and plodding up muddy trails, Grace enjoys scribbling notes and thinking up a storm. Her day job as a speech therapist involves helping children communicate, educating parents, and playing with lots of bubbles.
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