Cluster headaches are one of the more severe types of head pain. They are more common in men than women. The pain is usually constant, intense, and nonthrobbing, deep in and around the eye on one side of the head. Pain often moves into the forehead, temple, and cheek. Pain may leave as quickly as it began or fade slowly.
Cluster headaches are unpredictable. Several months can pass without headaches, but then they start again. They are rather rare, occurring in less than 1% of people, and are most common between adolescence and middle age.
The exact cause is unknown. Triggers can include drugs (nitroglycerin), certain foods, smoking, drinking alcohol, changing the normal sleep pattern, heat, and exposure to hydrocarbons (perfumes, petroleum solvents).
Headaches occur in groups or clusters. Each cluster usually begins in spring or fall and lasts about 2 to 3 months. Headaches may occur nightly after 1 to 2 hours of sleep or several times during the day and night. Each attack may last almost an hour. They often have a pattern, occurring at the same time each day for 6 to 12 weeks, followed by no headaches for many months or years. Other symptoms are watering eyes, drooping eyelids, and vision problems on the side of the headache.
The health care provider makes a diagnosis from the medical history and examination. Other tests are generally not needed. If the symptom pattern changes, the health care provider may order additional tests such as magnetic resonance imaging (MRI) of the head to look for other disorders that can mimic cluster headaches.
Many treatments exist for cluster headaches. The goal is to help symptoms because cluster headaches cannot be cured. Certain medicines can prevent more headache attacks. For breakthrough headaches (which occur even with preventive medicine), inhaling pure oxygen may provide some relief. The health care provider may prescribe oxygen therapy for use at home if breakthrough headaches occur often. If attacks are less frequent, drugs given by mouth, such as triptan medications, verapamil, or the steroid methylprednisolone, also work and are more convenient and less expensive than pure oxygen therapy.
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