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Cluster headaches

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 4 minutes read
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Cluster headaches (CH) are terrible attacks of pain – sometimes called the worst pain you can imagine - that affect one side of the head, usually around the eye. The cause for them is not completely clear but they have a tendency to run in families and occur more commonly in people that smoke. They can also be triggered by things such as alcohol and even strong smells. 

They aren’t very common but can affect anyone and usually occur in ‘clusters’. There are two types - episodic and chronic.  In episodic CH the attacks occur on a daily basis over a period of weeks or months and then stop as suddenly as they started, disappearing for weeks, months or even years before returning at some point.  In chronic CH, the attacks occur regularly with a pain-free remission of less than four weeks in any twelve-month period. 

In most episodic sufferers the headaches start at the same time of year and occur at the same time during the day or night, with each attack usually lasting between 15 minutes and 3 hours (or more), and can occur up to 6 or 8 times a day.  It’s also common for sufferers to experience an attack within 30-90 minutes of falling asleep.

What are the symptoms?

Cluster headaches occur in attacks and come on quickly. The attacks usually last for between 15 minutes and several hours and can happen multiple times a day. They are very severe, intense sharp pains on one side of the head or face. Commonly it happens around the eyes, causing pain behind the eye, and the eye can water and look bloodshot, or the pupil can look constricted (small). You may also experience a blocked or runny nose, and occasionally sweating.

When should I see my doctor?

If this is the first time you have ever experienced something like this, this pain can be very intense and feel quite frightening. You should speak to your doctor who will take a history from you and may refer you for further tests. A brain scan isn’t needed to diagnose a cluster headache as it will be normal, but a scan may be used to rule out any other serious causes of your symptoms. Your doctor may try you on some treatment to begin with but often they need to refer you to a brain specialist (neurologist) for further management. 

How is it treated?

Simple painkillers like acetaminophen and ibuprofen aren’t usually effective at treating cluster headaches. The symptoms of cluster headaches can be very debilitating and affect your ability to function when the attacks happen. If you've already been diagnosed, it may be worthwhile letting your employers know in advance so that they can make the necessary provisions. 

Your doctor may be able to prescribe you a medication to take as soon as an attack starts and this is a common drug called sumatriptan, which can be taken as an injection just underneath the skin or as a nasal spray. It's a drug that acts fast to reduce your symptoms, sometimes within 8-10 minutes after an injection, but tablets can take up to half an hour to work and sometimes don’t work at all. Sumatriptan isn’t a painkiller as such, but targets cluster headaches. Sumatriptan and other triptans also target migraines, and for this can be given as an injection, nasal spray or tablet, but the tablet form is often ineffective for cluster headaches.

Continuous inhalation of oxygen for 20 minutes using a mask without holes is also said to provide fast-acting pain relief and if you would like to try this type of treatment you’ll need to speak with your doctor about being prescribed it.

Transcutaneous vagus nerve stimulation uses a low dose electrical current to stimulate the nerves in your neck. They can be used for attacks and before attacks to prevent them. This is only available via a specialist.

Can I prevent them from happening?

The most important thing you can do is to try and identify any triggers that may cause your symptoms and avoid them. For some, this may be to avoid alcohol, for others it can be avoiding strong smells such as paint or perfume. Cluster headaches are more common in those who smoke, so it is advised to quit smoking. 

Your neurologist may consider starting you on regular medication to help prevent cluster headaches from happening in the first place. These have varying success rates. Examples of such medications include verapamil and steroids but these medications come with side effects, so it is best to consider all options thoroughly before starting them. 

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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