Cluster headache sufferers typically experience very severe headaches of a piercing quality near one eye or temple that last for between 15 minutes and three hours. The headaches are unilateral and occasionally change sides.

Cluster headaches are frequently associated with drooping eyelids, conjunctival injection (which results in red, watery eyes), tearing, constricted pupil, eyelid edema, nasal congestion, runny nose, and sweating on the affected side of the face. The neck is often stiff or tender in association with cluster headaches, and jaw and teeth pain is sometimes reported.

During an attack, the person often is unable to be still and may pace. Sensitivity to light is more typical of a migraine, as is vomiting, but they can be present in some sufferers of cluster headache.

In episodic cluster headache, these attacks occur once or more daily, often at the same times each day, for a period of several weeks, followed by a headache-free period lasting weeks, months, or even years. Approximately 10-15% of cluster headache sufferers are chronic; they can experience multiple headaches every day for years.

Cluster headaches are occasionally referred to as "alarm clock headaches", as they can occur at night and wake a person from sleep at the same time each night or at a certain period after falling asleep. Other synonyms for cluster headache include Horton's syndrome and "suicide headaches" (a reference to the excruciating pain and resulting desperation).

The location and type of pain has been compared to a "brain-freeze" headache from rapidly eating ice cream; this analogy is limited, but may offer some insight into the cluster headache experience. Persons who have experienced both cluster headaches and other painful conditions (childbirth, migraines) report that the pain of cluster headaches is far worse. One analogy is that of a burning ice pick being repeatedly stabbed through the eye into the brain.

Incidence

Whereas other headaches, such as migraines are diagnosed more often in women, cluster headaches are diagnosed in men at a rate 2.5 to 3 times greater than in women. Between 1 and 4 people per thousand experience cluster headaches in the U.S. and Western Europe; statistics for other parts of the world are fragmentary. Latitude plays a role in the occurrence of cluster headaches, which are more common as one moves away from the equator towards the poles. It is believed that greater changes in day length are responsible for the increase.

Pathology

While the immediate cause of pain is in the trigeminal nerve, the true cause(s) of cluster headache is complex and not fully understood. Cluster headaches are a type of vascular headache and the intense pain of an attack is also associated with the dilation of blood vessels.

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Cluster headaches: what you should know
From American Family Physician, 11/1/05

What is a cluster headache?

A cluster headache is a rare type of headache that is more common in men. Cluster headaches start suddenly. The pain is usually behind or around one eye and is very bad. If you have a cluster headache, your nose and eye on the same side as the pain may get red, swollen, and runny. Cluster headaches also can make it hard for you to sleep.

Most cluster headaches last for about 30 to 45 minutes. Sometimes, though, they can last only a few minutes or several hours. Cluster headaches usually happen at the same time each day for several weeks, until the "cluster" is over. Clusters usually last four to eight weeks.

What causes cluster headaches?

No one is sure what causes cluster headaches. They don't seem to be related to other illnesses, and they don't seem to run in families.

How can I tell if I have cluster headaches?

Your doctor will decide whether you have cluster headaches based on your symptoms. The time and pattern of headaches are very important, so keep a diary of your pain. Family members or others who see you during a headache can help by telling the doctor how you look and act. Don't be embarrassed to tell your doctor about things you have done to try to help the pain (such as banging your head against furniture). This is common, but will not help. Talking about them will help your doctor decide how bad the headaches are.

Your doctor also will give you a physical exam. He or she might want you to have tests to rule out other illnesses.

Can I do anything to keep from getting headaches once a cluster period has started?

During a cluster period, it is important to keep to your usual routine and try to stay calm. Do not change the times you wake up and go to sleep during a cluster period. This might bring on a headache. Drinking alcohol also will give you headaches during cluster periods. This can happen very quickly--even before you finish the first drink. Stress also may bring on headaches.

How are cluster headaches treated?

There are several ways to treat cluster headaches. It is important to talk to your doctor about the side effects of different medicines. He or she can help pick the right treatment for you and set up times for you to take your medicines.

Your doctor will probably want you to take two medicines. One medicine is taken during a cluster period to reduce the number of headaches. The second medicine is taken to help you feel better when you get a headache. Cluster headaches start too quickly for you to get medical help. You must be ready to take this medicine as soon as a headache starts. You might want to teach family members about your headaches and medicines so that they will be able to help you when you get a headache.

Medicines taken by mouth work too slowly to help with cluster headaches. Instead, your doctor might want you to take a medicine that you breathe in or take as a shot or put into your rectum. Other treatments that work for some people are breathing oxygen through a mask or using a numbing medicine in the nose.

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