Cluster Headache – Information

What is Cluster Headache?

  • Cluster headaches may have a genetic component, but are also associated with alcohol and caffeine over-consumption, smoking, stress, and low testosterone levels.
  • Clusters of headaches typically last for 2–12 weeks at a time, followed by periods of remission.
  • These headaches may occur at the same time each day, like an alarm clock, often early in sleep.
  • Sufferers tend to pace rather than seek sleep.
  • During an attack, both the same side carotid artery and the scalp may be tender.

How does Cluster Headache pain vary from other headaches?

The quality of pain associated with cluster headache is distinct:

  • Severe pain may cause waking from sleep.
  • Unilateral pain behind the eye that feels like a red-hot poker.
  • Typically occurs on the same side.
  • Rapid onset of pain that reaches its peak within 15 minutes.

Diagnostic criteria of the International Headache Society:

Cluster Headache Criteria

1. Headaches with:

  • Severe to very severe unilateral pain
  • Orbital, supra-orbital or temporal pain
  • Pain duration of 15–180 minutes
  • One sided Headaches

2. Associated with autonomic symptoms

  • Conjunctival injection and/or lacrimation (tears) and
  • Nasal congestion and/or rhinorrhoea and
  • Forehead and facial sweating and
  • Myosis and/or ptosis and
  • Eyelid oedema or
  • Restlessness or agitation

3. Headache frequency of eight times per day or once in 2 days;

  1. Headaches cannot be attributable to another condition.

The headaches may be further classified according to the timing of clusters as:

  1. Episodic: A duration of 7 days to 1 year, separated by remission periods of > 1 month or
  2. Chronic: A duration > 1 year with remission periods < 1 month.


  • Abortive therapy is difficult due to fast onset of headache and short duration.
  • Prophylaxis is the best management strategy as it is more effective than acute medication.
  • Medication has advantages and disadvantages.
  • Incorporating lifestyle changes into a treatment plan may help.
  • Avoiding alcohol, smoking and any aggravating foods, combined with regular exercise, sleeping and eating routines may also be beneficial.
  • Reducing stress and tension may help.
  • High-dose, high-flow oxygen therapy via an efficient mask is often helpful.
  • Sumatriptan subcutaneous injection during an acute episode may reduce the severity and duration of cluster headaches.

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