Cluster Headaches

A cluster headache is severe pain that is felt at the temple or around the eye on one side of the head, that lasts a relatively short time (less than 4 hours), and that usually occurs in groups for a 6- to 8-week period.

Cluster headaches are relatively rare, affecting about 1 to 4 of 1,000 people. Cluster headaches affect mostly men older than 30. Use of alcohol or nicotine may trigger attacks.

Symptoms

An attack almost always starts suddenly and lasts 15 minutes to 3 hours. It may begin with itching of or a watery discharge from one nostril. Intense pain on the same side of the head follows and spreads around the eye. The pain often awakens people from sleep. Because the pain is so severe, people with cluster headaches cannot lie down, frequently pace, and sometimes bang their heads. After the attack, the eyelid on the same side as the headache may droop, and the pupil often constricts. The headaches are usually not associated with nausea and vomiting and are not worsened by light, sounds, or smells.

Attacks may occur twice a week up to several times a day. They usually occur in groups or clusters for a 6- to 8-week period, occasionally longer, followed by a headache-free interval of several months before they recur. They may recur at the same time of day or night.

Diagnosis and Treatment

Diagnosis is based on the person's description of the headache and the accompanying symptoms. If the pattern of symptoms changes, computed tomography (CT) or magnetic resonance imaging (MRI) of the head is performed.

Most people with cluster headaches need to take drugs to prevent recurrences. Drugs include those used to prevent migraines, verapamil, lithium, indomethacin, and, occasionally, methysergide. Oxygen, given by nasal prongs, or the corticosteroid methylprednisolone, given by mouth, can stop (abort) a cluster headache as it is beginning.