The worst primary headache condition a person can have is cluster headaches. Identified in the 1990s by Dr. Peter Goadsby, these types of headaches involve extreme pain focused on one side of the head, usually in the region of the eye.

A rare type of neurological disorder, cluster headaches affect about 1 in 1000 individuals and are most commonly experienced by people in their 30’s and 40’s. While anyone can start having cluster headaches, the neurological condition is often seen in men more than women – and is generally non life threatening.

What are the Types of Cluster Headaches?

Cluster headaches are classified into two types: episodic and chronic. 

Episodic cluster headaches usually last for anywhere between seven days to one year. After a bout of episodic cluster headaches, individuals typically experience no symptoms of the headache condition for several months.

Chronic cluster headaches are far more intense and long-lasting. Of those diagnosed with cluster headaches, 2 in 10 are chronic sufferers. Chronic cluster headaches are persistent, lasting more than a year and offering less than three months respite from bouts.

What are the Symptoms of Cluster Headaches?

Cluster headaches are called such because of the frequency in which they occur. Unlike migraines that occur in one-off situations triggered by different events and environmental factors, cluster headaches will occur in batches over a few weeks or months, followed by long remission periods up to a year. In many cases, cluster headaches are experienced multiple times a day, with some patients reporting up to 10 cluster headaches per day.

Those who experience cluster headaches report symptoms that include:

  • Severe pain on one side of the head
  • Unbearable, intense pain behind or around the eye
  • Numbness and tingling sensations on one or both sides of the face
  • Watery or teary eyes
  • Drooping in eyelids
  • Itchiness, redness, and soreness of the face
  • Runny nose
  • Sinusitis & Nasal Congestion
  • Extreme miosis of the pupils
  • Excessive facial sweating 

The pain of a cluster headache attack is often described as a boring or drilling sensation that can last up to two hours at a time per episode. During these cluster periods, individuals may also experience symptoms similar to migraine aura that include sensitivity to light and sound, nausea, and vomiting.

However, the majority of individuals that suffer from cluster headaches have no warning before the pain strikes.

What Causes Cluster Headaches?

Thought to result from irregular hypothalamus activity and neurological abnormalities within the trigeminal nerve, cluster headaches are not triggered by the same factors as other severe headache conditions such as migraines.

Some evidence would suggest that the onset of cluster periods seems to be influenced by seasonal changes that affect natural biorhythms. This would make sense as our body’s biological clock is controlled primarily by the part of the brain called the hypothalamus. As such, those with irregular hypothalamus activity may be more likely to suffer from cluster headaches during seasonal changes.

Additionally, as the hypothalamus also regulates sleep patterns, some scientists believe that those who aren’t getting the proper amount of sleep may also be more susceptible to cluster headaches.

These causes, however, are not indicative one way or another whether someone is susceptible or guaranteed to get cluster headaches. Many individuals who suffer from cluster headaches have episodes even with good sleep patterns and regular biorhythms.

How to Diagnose a Cluster Headache?

Individuals need to seek a neurologist or healthcare professional specifically trained in recognizing neurological disorders to diagnose a cluster headache.

Be aware that a neurology specialist won’t be able to use medical equipment to determine whether or not an individual is suffering from cluster headaches, as there is no test that can be performed to detect this neurological disorder.

Neurologists will use CT scans and MRIs to rule out other neurological conditions to diagnose cluster headaches accurately. Once other conditions such as brain tumors, aneurysms, and arteriovenous malformations have been ruled out, the diagnosis of cluster headache is more likely.

Additionally, a healthcare professional will ask several questions to confirm the symptoms that are associated with those suffering from cluster headaches. It is essential to answer all of these questions to ensure that treatment options are customized to the specific condition. Failure to answer all questions accurately and honestly may result in ineffective treatment options.

What Are the Treatments for Cluster Headaches?

Once cluster headaches have been diagnosed, neurologists will work with patients to develop treatment plans that effectively manage their symptoms. Because there is no cure, cluster headache treatment focuses on managing pain and reducing the number of attacks experienced per day. The most common treatments include:

  • Nasal sprays containing ergotamine and dihydroergotamine
  • Natural supplements such as CBD oil (see Blessed CBD)
  • Corticosteroids including prednisone
  • Mood stabilizers such as lithium to regulate irregular hypothalamus activity
  • Beta blockers such as triptan and sumatriptan
  • Anti-seizure medication containing topiramate
  • Opioids such as zolmitriptan
  • High flow oxygen therapy
  • Neurostimulation with the use of occipital nerve blockers
  • Calcium channel blockers such as verapamil

Individuals find that high-flow oxygen, opioids, beta blockers, and nasal sprays are more effective as acute treatments for cluster headaches. These work fast and typically provide immediate relief from the pain. The side effects associated with the short-term treatment of cluster headaches are usually minimal and resolve once an individual has stopped using these medications.

To ensure the longest span between cluster headaches, individuals will use corticosteroids, mood stabilizers, anti-seizure, and occipital nerve blockers primarily as preventive treatments. These preventive medications are designed to be taken daily for an extended period of time to remain pain-free.

Additionally, the FDA has recently approved a non-invasive nerve stimulation device used to counter nerve blocks with deep brain stimulation that reduces the number of cluster headaches felt per day. This treatment is ideal for those who do not wish to take prescription and over-the-counter medications to manage their cluster headaches.

Cluster Headaches Resources

For those who think that they or a loved one is experiencing cluster headaches, it’s essential to seek out medical treatment and a diagnosis to avoid unnecessary pain and suffering. While there is no cure for cluster headaches, individuals can learn how to manage their condition with various treatments.

To better understand what cluster headaches are and how to treat them, it’s recommended to consult resources offered by the American Migraine Foundation, the International Headache Society, the National Institute of Neurological Disorders, and the Mayo Clinic.

These organizations are dedicated to helping individuals who suffer from cluster headaches and other extreme headache disorders find trained medical professionals, local support groups, and access to educational resources.