Share this on:Copied!

Cluster headaches are statistically among the most painful types of headaches. People who suffer from them report pain levels of 10 out of 10 during acute attacks.

They describe recurring bouts of intense pain around the eyes, temples, and forehead. The pain occurs with at least one autonomic (involuntary) symptom, such as tearing or sinus congestion. Cluster headaches are a rare condition that most commonly affects men around the age of 30.

Find out more about this understudied and underdiagnosed headache condition, as well as ways you can manage cluster headaches when they occur.

What Are Cluster Headaches?

Cluster headaches are the most common and severe form of a group of headache disorders called trigeminal autonomic cephalalgia (TAC). The trigeminal nerve, the fifth cranial nerve in the brain, controls facial sensations and functions like biting and chewing.

TAC or cluster headaches often involve attacks of intense nerve pain around the eyes, temples, and forehead. A TAC diagnosis requires at least one autonomic (involuntary) symptom, such as tearing, nasal congestion, or eyelid swelling, on the same side as the pain.

There are two types of cluster headaches:

• Chronic cluster headaches — These affect 15% to 20% of people with cluster headaches. Getting diagnosed requires having symptoms for more than a year without remission, or with a remission of less than one month. Of those who get this, 10% to 20% will develop drug resistance during treatment.
• Episodic cluster headaches — These affect 85% to 90% of people with cluster headaches. They happen every day or every other day for weeks or months (most often in spring or fall), then go into remissions lasting months to years.

What do cluster headaches feel like?

Cluster headaches are among the most painful types of headaches. Those who have them often describe the pain they cause as explosive and non-fluctuating.

People with cluster headaches often rock back and forth or pace to relieve or distract from the intense pain.

Attacks of cluster headaches can last anywhere from 15 minutes to three hours. They can occur up to eight times a day, often at the same times of day. Many people report two attacks a day, mostly at night.

Daily attacks can continue for weeks or months and then go into remission for months or years. This pattern usually lasts up to 15 years.

What’s the Quickest Way to Treat a Cluster Headache?

The best treatment for a cluster headache attack is 100% oxygen therapy, which works quickly — often in 10 minutes or less. Oxygen therapy involves inhaling pure oxygen through a mask connected to an oxygen tank. According to the National Institutes of Health, oxygen therapy is effective for at least 66% of people with cluster headaches.

Other quick-acting treatments for cluster headaches include:

• Triptans — Medications that help constrict blood vessels in the brain and reduce inflammation around nerves. Triptans are available as an injection or nasal spray to stop a cluster headache.
• Vagus nerve stimulation (VNS) — A device that delivers mild electrical pulses to interrupt a cluster headache.

Other medications for treating cluster headaches include:

• Ergotamine.
• Intranasal lidocaine.
• Octreotide.

Cluster headaches aren’t only hard to diagnose, they’re also hard to treat. Up to 20% of people with chronic cluster headaches will develop drug resistance because the medications stop working for them.

When drugs no longer work, a surgery called deep brain stimulation (DBS) may help. DBS involves the surgical implantation of a small device to prevent cluster headaches.

What Treatments Can Prevent Cluster Headaches?

Your health care provider may prescribe medications to prevent cluster headaches from occurring in the first place.

Treatments to prevent cluster headache attacks include:

• Glucocorticoids, such as oral prednisone.
• Intranasal capsaicin.
• Lithium.
• Melatonin.
• Suboccipital blockade.
• Valproic acid.
• Verapamil.

How Can I Manage My Cluster Headaches?

Here are some practical strategies for managing daily cluster headaches.

Identify — and avoid — your triggers

One key way to prevent cluster headaches is to identify what triggers yours and avoid those activities.

Try keeping a daily headache diary for at least a month. Record the date your headache occurred, the location of your pain, what you were doing immediately before it started, and how long it lasted.

These details can help you and your doctor identify a pattern of what’s causing your headaches. This can allow you to avoid these triggers and potentially prevent future headaches.

Activities known to trigger cluster headaches include:

• Drinking alcohol.
• Exercising.
• Getting sexually aroused or having sex.
• Hot weather.
• Seeing glare.
• Smoking or smelling secondhand smoke.
• Smelling strong perfume or flowers.
• Smelling nail polish, paint, or varnish.
• Stress.
• Taking nitroglycerin medication.
• Traveling at high altitudes.
• Watching television.

Eating certain foods can also lead to cluster headaches. Known potential cluster headache-triggering foods include:

• Artificial sweeteners.
• Caffeine.
• Chocolate.
• Citrus fruits.
• Cured meats.
• Eggs.
• Monosodium glutamate (MSG).
• Nitrates.
• Onion.
• Peanuts and tree nuts.
• Shellfish.

Avoid these activities and foods if they bring on cluster headaches.

Take your preventive medications as instructed

If your doctor has prescribed you preventive medication for your cluster headaches, take it at the recommended time of day. If they don’t recommend a specific time, take it at a time that is convenient for you, and then try to take it at that same time every day.

Medication consistency helps prevent dips in dosage levels, which can reduce the medicine’s effectiveness and potentially lead to breakthrough headaches.

Adopt stress reduction and management techniques

Stress and body tension can make cluster headaches even worse. Work to manage your stress by adopting stress-reduction techniques that you can use daily.

Some stress management techniques that can help with headaches include:

• Aromatherapy — Essential oils such as lavender, peppermint, or eucalyptus can help promote relaxation and alleviate headache symptoms.
• Biofeedback — Uses electronic monitoring to help you gain control over certain bodily functions, such as muscle tension and heart rate. This can help manage stress and prevent headaches.
• Cognitive behavioral therapy (CBT) — This type of therapy can help you identify and change negative thought patterns and behaviors that contribute to stress and headaches. An association exists between cluster headache attacks and suicidal ideation.
• Deep breathing exercises — Deep, slow breathing can help calm the nervous system and reduce stress levels.
• Eat a healthy diet — A balanced diet and good hydration can help maintain overall health and reduce the likelihood of headaches.
• Get adequate sleep — Ensuring you get enough quality sleep each night can help reduce stress and prevent headaches.
• Mindfulness and meditation — Mindfulness practices and meditation can help you stay present and reduce stress, which can, in turn, help prevent headaches.
• Progressive muscle relaxation — Involves tensing and then slowly relaxing each muscle group in the body. This can help reduce physical tension and stress.
• Work out — Regular exercise, such as walking, swimming, or cycling, can help reduce stress and improve overall well-being.
• Yoga — Can help with daily management by reducing anxiety and stress, improving sleep, regulating nervous system activity, and developing more mind-body awareness.

Maintain a consistent schedule

Try these tips for keeping a consistent schedule:

What Causes Cluster Headaches?

The cause of cluster headaches remains unknown. Studies have found connections among the trigeminovascular pain system, the hypothalamus in the brain, and the autonomic nervous system.

Hormonal changes are another possible factor. Research has shown decreases in serum testosterone levels and changes in cortisol and melatonin levels in men during active bouts of cluster headaches.

Some degree of genetic relationship also exists. People who have a first-degree family member with cluster headaches are 18 times more likely to have a cluster headache diagnosis themselves.

Key risk factors for cluster headaches are:

• Drinking alcohol.
• Having a family history of cluster headaches.
• Having prior brain surgery or head trauma.
• Having sleep apnea.
• Smoking cigarettes.
• You’re between the ages of 20 and 40.
• You’re male.

What Are the Symptoms of a Cluster Headache?

The key symptom of cluster headaches is extreme pain (rated 10 out of 10). The pain most often occurs around or above an eye. At least one autonomic system symptom on the same side of the body as the headache must accompany it.

In addition to severe headaches, common autonomic symptoms include:

• Allodynia — Feeling pain from something that normally should not hurt, such as a light touch or gentle pressure.
• Excessive eye tearing.
• Facial and forehead sweating.
• Inability to hold still, rocking in place, or pacing.
• Nasal congestion.
• Sense of restlessness or agitation.
• Swollen eyelids or forehead.

Other cluster headache symptoms include:

• Miosis — Excessive constriction of the eye’s pupil.
• Photophobia — Sensitivity to light.
• Phonophobia — Sensitivity to sound.
• Ptosis — Droopy eyelid.

Because they affect only 0.1% of the population, cluster headaches remain understudied and underdiagnosed. Typical time to diagnosis is five years for most people with cluster headaches. This makes recognition of symptoms vital to proper diagnosis and treatment.

When Should I See a Doctor About My Cluster Headaches?

If your cluster headaches are new, schedule an appointment with your health care provider for a diagnosis and to rule out other potential issues.

If you have a cluster headache diagnosis but your headache patterns have changed or your pain has increased, you might want to see a neurologist or headache specialist.

If you have a cluster headache and confusion, fever, nausea, numbness, seizures, a stiff neck, or any neurological symptoms, such as drowsiness, movement difficulties, or vision loss, seek emergency care.

What is the prognosis for cluster headaches?

About 25% of people who experience a cluster headache will never have another one. Another 15% to 20% will have chronic cluster headaches, 10% to 20% of whom will develop drug resistance. The cycle of cluster headaches typically lasts about 15 years.

Many people experience mental health issues, physical burdens, and loss of quality of life due to their cluster headaches. Some also describe suicidal ideation, but actual follow-through action is rare.

It’s essential to seek care from a team of specialists if cluster headaches are significantly impacting your life. Look for a provider who offers access to a team of neurologists, headache specialists, and mental health professionals to get the most comprehensive care for cluster headaches.