Getting to Know the Symptoms & Treatment Options for Cluster Headaches

Cluster headache is a relatively rare type of headache. People typically experience short, incapacitating attacks that present on one side of the head around the eye, forehead and temple, says Dr. Stewart Tepper, a neurologist and vice president of external research at at the New England Institute for Neurology & Headache. Dr. Tepper previously worked at the Geisel School of Medicine at Dartmouth, and while there he spoke with the American Migraine Foundation about the causes of cluster headache, the various physical symptoms, treatment options, and ongoing research. Read on below.

What is Cluster Headache?

“We call cluster headache a primary headache in that it’s not due to other disorders,” Dr. Tepper says. People can experience cluster headache in a variety of ways. These headache attacks most often occur one to three times a day, but can occur up to eight times a day. Unlike with migraine or other types of disorders that cause severe headache, patients experiencing an attack do not seek relief in a dark, quiet room. “Instead, they run around, rock their bodies and are usually very agitated,” says Dr. Tepper. Cluster headache also differs from migraine in that it is more common in men, especially middle-aged men who are smokers.

The most common types of cluster headache are episodic cluster headache, in which people experience daily attacks for a period of time before periods of time with no headaches, and chronic cluster headache, in which people experience regular daily attacks without a period of relief. “We don’t know the actual cause of cluster headache, but we do know the anatomy behind it,” Dr. Tepper says. Cluster headache attacks generally start in the area of the brain called the hypothalamus, which also controls our circadian rhythm.

Physical Symptoms of Cluster Headaches

People living with cluster headache typically have cranial autonomic symptoms, which occur on the side of the face with head pain. According to Dr. Tepper, these symptoms can include the following on the same side as the headache:

  •      Tearing from the eye
  •      Runny or stuffy nose
  •      Red or droopy eye
  •      Small pupil
  •      Sweating or swelling of the face

Current Treatment Options for Cluster Headache

Dr. Tepper has one very important piece of advice for patients living with cluster headache: Get to a headache specialist. “Most cluster patients we can treat,” he says. A headache specialist can help you determine the best course of treatment for your symptoms and your lifestyle.

When it comes to evaluating the best treatment for you, consider three types of treatments: acute (break a headache), transitional (short-term, quick-acting preventives) and preventives (traditional long-term preventive treatments). All patients should have an acute treatment, while transitional therapies, which typically consist of oral steroids or injections of occipital nerves with an anesthetic and a steroid, can help shorten attack periods more quickly. Depending on a patient’s allergies, other health problems, and the duration of their headache periods, headache specialists typically administer transitional treatments while incorporating preventive treatments such as daily oral verapamil.

“We can also treat cluster headache on an acute or as-needed basis,” says Dr. Tepper. “This is important because every single attack needs to be treated.” Two FDA-approved medications for terminating cluster headache are currently available: sumatriptan and injectable dihydroergotamine (DHE). However, Dr. Tepper says, one of the most, if not the most, effective treatment options is oxygen. “We recommend patients breathe through a non-rebreathing mask at a high rate of oxygen flow,” he says. “Generally, around 80 percent of attacks can be terminated by oxygen within 20 minutes.”

In addition, the FDA has approved a portable device without significant side effects—the non-invasive vagal nerve stimulator—for the acute treatment of episodic cluster headache attacks. A person turns on the device and holds it to the neck for three cycles of two minutes at the start of an attack. This device is now commercially available with a prescription. It was not found effective in terminating chronic cluster headache attacks.

The American Migraine Foundation has an extensive collection of information on cluster headache and other disorders that cause severe headache in our resource library. Use our Find a Doctor tool to locate a headache specialist in your area, and discover your support community by joining the Move Against Migraine Facebook Group.