24th, November 2022


Cluster headaches

Cluster headaches are a sequence of daily, rather short-lasting, excruciating headaches that can last for weeks or months. They usually come at the same time every year, such as in the spring or fall. As a result, cluster headaches are frequently misdiagnosed as allergies or stress-related symptoms.

The exact origin is unknown, but a nerve in your face is implicated, causing excruciating agony near one of your eyes. It’s so bad that most people can’t sit still and pace a lot when they’re having an attack. Although cluster headaches typically don’t last as long as migraines, they might be more painful.

Less than one in 1,000 persons experience these headaches, making them the least frequent form. They are more common in men than in women. They typically begin before the age of 30. For months or years, cluster headaches may entirely disappear (this is known as going into remission), but they can return suddenly.

What Occurs

When a neural route in the base of your brain is activated, you experience cluster headaches. The hypothalamus, a deeper region of the brain that houses the “internal biological clock” that regulates your sleep and waking cycles, appears to be the source of that signal.

The trigeminal nerve, which is damaged, is in charge of feelings like heat or discomfort in your face. It starts close to your eye and branches out above your ear on the same side, across your cheek, along your jaw, and up to your forehead.

These headaches are not brought on by a tumour or aneurysm in the brain.

Cluster Headaches: Their Features

There are a few characteristics that distinguish this kind of headache. They consist of:

  • In 5 to 10 minutes, cluster headaches typically reach their peak intensity.
  • When you’re experiencing daily attacks, it’s usually always on one side of your head and stays there for a while. (On rare occasions, the headache may shift to the opposite side as a new headache period begins.) It is frequently described as piercing or searing. It could be throbbing or never-ending. It will be felt behind or near one eye. Your forehead, temples, nose, cheek, or upper gum on that side could all be affected. Your scalp might be sensitive. Your pulse can frequently be felt.
  • brief in duration. The typical duration of a cluster headache is 30 to 90 minutes. They can last anywhere from 15 minutes to 3 hours, but they eventually go. These headaches are likely to occur one to three times per day for you. Others receive them up to eight times every day, while some only receive one every other day.
  • Attacks appear to be related to your body’s internal 24-hour schedule, the circadian rhythm. They are known as “alarm clock headaches” because they typically occur at the same time every day and so frequently. Even a few hours after you go to bed, they might wake you up. A nighttime assault may be more serious than one during the day.


The pain typically begins quickly, frequently in the area of or behind the eye. You might observe:

  • Pain or a little burning sensation
  • eye swelling or drooping
  • The pupil of the eye is smaller.
  • Red or watery eyes
  • clogged or runny nose
  • a warm, rosy face
  • Sweating
  • responsiveness to light
  • Pacing, restlessness, or agitation

Smokers and heavy drinkers are more likely to experience cluster headaches. You’ll be more susceptible to alcohol and nicotine during a cluster phase. Even a small amount of alcohol might cause a headache. However, when there are no headaches, drinking won’t result in one.


Any of these can cause a headache while you are experiencing a cluster period:

  • tobacco smoke
  • Alcohol
  • strong odours
  • Increase the altitude
  • glaring light
  • Effort or exercise
  • Heat nitrate-containing foods like bacon and lunch meat.
  • Cocaine

Cluster headaches versus migraines

The discomfort from both forms of headaches is severe. However, they hurt differently and you feel them in different places.

The duration of a migraine headache might range from a few hours to many days. Up to a day before the discomfort begins, you could experience some warning symptoms including food cravings or mood swings. Auras may also be present shortly prior to the migraine attack.

You have throbbing agony from a migraine. A migraine may hurt on both sides of your head, just one side, or along your forehead, whereas a cluster headache typically just hurts one side of your head. Moving your head will likely make it worse. You might also:

  • nausea and diarrhoea
  • Light, sound, and scent sensitivity
  • Auras are coloured dots, lines, flashing lights, or sparkles that appear in your field of view.
  • tingling or numbness
  • Weakness
  • speech or hearing difficulties

You could experience a sort of “hangover” after a migraine, where you feel exhausted or disoriented. Your doctor could refer to this time as the postdrome phase.

A migraine can be brought on by numerous reasons, including:

  • alterations in the climate
  • excessive or insufficient slumber
  • strong odours
  • Stress
  • loud sounds
  • food is not enough
  • Depression or anxiety
  • certain medications
  • hormone alterations
  • Certain meals, caffeine, and food additives

When it comes to treating cluster headaches, you have a number of options:


When a headache strikes, these therapies are helpful:

Triptans. One of the finest ways to relieve pain is with these medications. You might be prescribed Zolmitriptan (Zomig), dihydroergotamine, or sumatriptan (Imitrex, Onzetra Xsail, Sumavel, Zecuity, or Zembrace SymTouch), which can be administered orally or topically (DHE 45). The ergot fungus serves as the basis for this prescription drug.

Octreotide. This is a synthetic version of the growth hormone somatostatin. You administer it intravenously (IV).

Lidocaine. This is a nasal spray that acts as a pain reliever.

Oxygen. Your doctor can refer to it as oxygen breathed. For 15 minutes, you’ll breathe it in using a face mask.

Often, preventive medicine can ward off headaches before they begin. Your doctor may recommend the following drugs to lessen the severity of attacks and shorten clusters:

  • Prednisone and other corticosteroids
  • Divalproex sodium (Depakote)
  • Galcanezumab (Emgality) (Emgality)
  • tartrate of ergotamine (Cafergot, Ergomar)
  • Gabapentin (Gralise, Neurontin) (Gralise, Neurontin)
  • Carbonate of lithium
  • Topiramate (Qudexy XR, Topamax, Trokendi XR) (Qudexy XR, Topamax, Trokendi XR)
  • Verapamil (Calan, Verelan) (Calan, Verelan)

Block of the occipital nerve (your doctor may also call it occipital nerve injection). A mixture of anaesthetic and steroid will be injected by the doctor into these nerves. They are located near the base of your skull and are frequently where headaches begin. This is a stopgap measure until a preventative may begin to take effect.

stimulating the nerves. In the event that medication is unsuccessful, some people find success using

  • activation of the occipital nerve. A device that electrically stimulates this cluster of nerves at the base of your skull is surgically implanted by your doctor.
  • Among these noninvasive devices, the FDA has approved:
  1. Your supraorbital nerve receives signals from a controller that resembles a headband when electrodes are placed on your forehead.
  2. This device also referred to as a non-invasive vagus nerve stimulator (nVNS), sends signals to this nerve via electrodes.


If everything else fails, surgery may be a possibility for those who experience cluster headaches continuously.

Less invasive alternatives are becoming preferred over deep brain stimulation, which entails inserting an electrode deep inside the brain.

The trigeminal nerve, a major conduit for pain, is typically blocked during treatments. It regulates the area around your eyes, but if you make a mistake, it could weaken your jaw and cause you to lose feeling in your face and head.

alterations in way of life

You can prevent cluster headaches by taking these actions:

  • Maintain a consistent sleep routine. A headache may start as a result of a routine alteration.
  • Ignore booze. When you are experiencing a cluster series, any type, including beer and wine, can cause a headache attack.

Additional therapies

Consult your physician about:

  • This painkiller may be sprayed in the nose for relief.
  • This drug, which is effective in treating sleep issues like jet lag, may lessen headache frequency.

Breath control drills

Breathing exercises actually change your body in ways that keep you calm and reduce stress. They can also be an important component of treatment for those who suffer from tension headaches or migraines.

However, can they stand up to the excruciating pain of a cluster headache? Despite the lack of evidence to support it, some doctors believe they should be tried. After all, there is no risk, and there is no expense to you.

Anxiety can be reduced by breathing exercises. Therefore, if you’re concerned about having another attack, they can help you keep calm and collected.

You can experiment with various breathing methods. Whichever one you choose, it’s beneficial to:

  • Locate a peaceful area where you won’t be disturbed.
  • Get comfy and take a seat.
  • For a while, put your problems aside.

Additionally, it’s essential to schedule time for it each day. Your body will become more accustomed to falling into breathing more effortlessly when you need it with consistent practise. It will be tougher to truly delve into it if you just do it when you’re in pain.

Also, keep in mind that these workouts are not a substitute for medication. They should be used in addition to your standard course of treatment.

inhaling deeply. You typically breathe more quickly while under stress or anxiety. This workout aids in your reset. Breathing slowly, deeply, and steadily is the goal:

  • Pay attention to your belly button. Perhaps you should lend a hand to assist there.
  • Draw air into your belly as you inhale through your nose. As you inhale, feel it become larger.
  • Lengthen and slowly exhale via your nostrils. Empty your lungs while you draw in your stomach. You can even tell yourself to calm down.

Your nervous system slows down with each deep, complete breath.

breathing in a rhythm. This exercise will assist you in slightly slowing down your breathing if it is typically quick and short:

  • Slowly inhale through your nose while counting to five.
  • As you count to five, take a slow, deep breath out through your nose.
  • Check to see if you can relax with each breath as you repeat the exercise.

As you get more at ease, you communicate with your body to increase your relaxation.

breathed mentally. For this one, you breathe while seeing the following:

As you get more at ease, you communicate with your body to increase your relaxation.

breathed mentally. For this one, you breathe while seeing the following:

  • Make yourself comfortable, shut your eyes, and take a deep breath.
  • Imagine peaceful air filling your lungs as it expands your chest and belly as you inhale through your nose. Think about relaxing your breathing more and more.
  • Imagine pushing the tension out together with your breath as you exhale.
  • Breathe in calmly and exhale stress repeatedly.

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