What is cluster headache?

Cluster headaches are very painful. They happen on one side of the head and often start at night. They can last for 30 minutes to several hours. They usually occur in groups, or clusters, over weeks or months. You may have a stuffy nose and watery eyes during the headaches. The cause of cluster headaches is not known.

Medicine may help prevent cluster headaches. You also can try to avoid things that trigger your headaches.

The main symptom of cluster headaches is a severe burning or sharp, piercing pain on one side of your head. The pain spreads out from your temple and eye. Your eye may become red, watery, or puffy. The eyelid may droop, and you may have a runny or stuffy nose on that side of your head.

The pain usually gets bad very fast. The pain gets worse within 5 to 10 minutes after the headache starts and can last for 15 minutes or longer.

Cluster headaches usually happen at the same time of day each time you get them. But they can happen at any time. You may have 1 to 8 headaches a day.

When a headache starts, you can take medicine or breathe in oxygen from a machine to ease the pain or stop the headache. You use these treatments only when you feel a headache coming on. You don't use them every day.

When a cluster headache begins:

• Start your treatment right away. Don't wait for the headache to get worse. Take your medicine exactly as planned with your doctor.
• Do what feels best. You may feel better if you walk, jog in place, sit, kneel, or stand. Lying down may make the pain worse.

If your treatment doesn't work, ask your doctor if you can try something else. It may take time to find what works best for you.

Over-the-counter pain medicines, such as aspirin, acetaminophen, and ibuprofen, usually don't work for cluster headaches.

Dealing with repeated cluster headaches can lead to stress and depression, which in turn can continue the headache cycle. Finding ways to cope with stress (such as with regular exercise) and improve depression may reduce the severity or frequency of your cluster headaches.

There is no cure for cluster headaches. You can't do anything to prevent a cycle of cluster headaches from starting.

But as soon as a cycle starts, you can take medicine that may help prevent more headaches or reduce how many you have during a cycle. You take this medicine every day during the cycle.

Certain things may be more likely to cause a headache during a cycle. These are called triggers. Avoiding them may help prevent headaches. Triggers include:

• Drinking alcohol.
• Sleep problems. It's best if you go to bed and wake up at the same time every day. Don't take naps.
• Increases in body temperature. This can happen when you exercise, take a hot bath, or get angry.
• Nitrates. These are found in wine, cured meats, aged cheeses, and some medicines.
• Histamine. Seasonal allergies could trigger a headache.

A headache diary can give you and your doctor clues to help you manage your headaches. Write down when and how often the headaches happen, how severe they are, and what you think may be causing them. Share this with your doctor.

A doctor can usually tell if you have cluster headaches by asking about your symptoms and examining you. Your doctor may order other tests, such as a CT scan or an MRI, if he or she thinks your symptoms are caused by another disease. But most people won't need these tests.

Medicines may stop a cluster headache after it starts or prevent more headaches from occurring. If you don't get headaches often, you may only need to take medicines after the headaches begin. If you get headaches often, you may need to take medicines daily during a cluster period to prevent a future headache or reduce the number of headaches in a cycle.

The choice of medicine may depend on the time of day when your headaches tend to occur. Some people may need a combination of two or three medicines. Finding the right medicine can take some time. Keeping track of your symptoms can help your doctor determine the proper medicine. You can keep track by using a headache diary.

When a cluster headache occurs, it is important to treat it as early as possible with the medicine your doctor has recommended. The sooner you treat the headache, the less painful it may be.

To stop a cluster headache

Treatments most often used to stop cluster headaches include:

High-flow oxygen inhalation therapy.

You breathe oxygen through a face mask to relieve headache pain. Oxygen therapy is one of the best treatments to stop a cluster headache. Oxygen therapy relieves headache pain within 15 minutes in more than 7 out of 10 people who use it. It works best when started right when a cluster headache starts. But you need to repeat the treatment when the next headache begins.

Triptans.

Triptans can be given as a shot, sprayed in the nose, or taken by mouth as a pill to reduce pressure and pain.

Octreotide.

Octreotide can be used as a shot to stop headache pain.

Lidocaine.

Lidocaine is taken by nose drops to stop severe headache pain.

Ergotamine preparations.

These can be given as a pill or in a vein to relieve pressure and reduce headache pain.

To prevent headaches during a cluster period

Some medicines that prevent cluster headaches during a cluster period include:

Suboccipital steroid injection.

This medicine is used to reduce the number of headaches in a cluster cycle. These may be given either as a single injection or a series of injections.

Verapamil.

This medicine is used to prevent or reduce the number of headaches in a cluster cycle. Verapamil is commonly used for preventing both occasional and chronic cluster headaches.

Lithium.

This medicine is often prescribed to prevent chronic cluster headaches.

Ergotamine.

This medicine can be used at bedtime to prevent cluster headaches overnight.

• Watch for new symptoms with a headache. These include fever, weakness or numbness, vision changes, and confusion. They may be signs of a more serious problem.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• If your doctor recommends it, take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Carry medicine with you to quickly treat a headache.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• If your doctor prescribed at-home oxygen therapy to stop a cluster headache, follow the directions for using it.

To prevent cluster headaches

• Keep a headache diary. Avoiding triggers may help you prevent headaches. Write down when a headache begins, how long it lasts, and what might have triggered it. This could include stress, alcohol, or certain foods.
• Exercise daily to lower stress.
• Limit caffeine by not drinking too much coffee, tea, or soda. But do not quit caffeine suddenly. This can also give you headaches.
• Do not smoke, and avoid being around others who are smoking. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Tell your doctor if your headaches get worse and medicines don't help. You may need to try a different medicine.

Cluster headaches are severe headaches on one side of your head that happen in groups, or "clusters." They usually occur over weeks or months.

Cluster headaches can be so painful that you are not able to follow your normal routine or do your usual activities. The pain is often called the worst type of headache pain.

Cluster headaches come in cycles (also called cluster periods). Most people who get cluster headaches have one or two cluster periods each year. A cluster period might last 1 month or longer. After a cluster period ends, you may not get another headache for months or even years.

As you get older, it's likely that you'll have longer and longer times without headaches. At some point, you may not get cluster headaches ever again.

Having cluster headaches can be scary. But even though they are very painful, cluster headaches don't cause long-term harm. During a cycle, you may be able to reduce how often you have them, how bad they are, and how long they last.

Experts aren't sure what causes cluster headaches. They run in families, but it's not clear why some people get cluster headaches and others don't.