Why cluster headaches

Pain from cluster headaches can be extremely severe. Cluster headaches are most common between adolescence and middle age, but can occur at any age. Older studies showed that cluster headaches were more commonly reported by men than women, such as a study published in Cephalagia , which shows that before , men reported cluster headaches six times more often than women. Over time however, that gap has shrunk, and by the s, cluster headaches were found in only twice as many men than women.

Episodic cluster headaches occur regularly between one week and one year, followed by a headache-free period of one month or more. Chronic cluster headaches occur regularly for longer than one year, followed by a headache-free period that lasts for less than one month.

A person who has episodic cluster headaches may develop chronic cluster headaches, and vice versa. Cluster headaches usually start suddenly. A small percentage of people experience aura-like visual disturbances, such as flashes of light, before headaches begin. Most commonly, headaches begin a few hours after you fall asleep and are often painful enough to wake you, but they may also begin when you are awake. Headache pain becomes severe minutes after the headache starts.

Each headache usually lasts for several hours, with the most intense pain lasting between 30 minutes and 2 hours. Cluster headache pain occurs on one side of the head, but can switch sides in some people, and is generally located behind or around the eye. It is described as a constant and deep burning or piercing pain.

People with this pain say it is like a hot poker being stuck into your eye. The pain may spread to the forehead, temples, teeth, nose, neck, or shoulders on the same side. The pain from cluster headaches is caused by the dilation, or widening, of the blood vessels that supply blood to your brain and face. This dilation applies pressure to the trigeminal nerve, which transmits sensations from the face to the brain.

It is unknown why this dilation occurs. Researchers believe that abnormalities in the hypothalamus, a small area of the brain that regulates body temperature, blood pressure, sleep, and the release of hormones, may be responsible for cluster headaches.

Cluster headaches may also be caused by a sudden release of the chemicals histamine, which fight allergens, or serotonin, which regulates mood. This would change the electrical impulses in the brain. Most people with cluster headaches take short- and long-term medications. When each period of clusters is over, the short-term treatments stop, but the long-term ones may continue. If attacks occur frequently, or if one lasts over 3 weeks, preventive treatments are recommended.

The person will take the treatment the moment the headaches start, and continue until the period of headaches ends. Long-term drugs are taken throughout the cluster period. Some people may need more than one long-term medication.

Symptoms include intense pain that starts rapidly, usually without warning. Pain is continuous rather than throbbing. It has been described as stabbing, sharp, burning, and penetrating. It often starts around the eye, and it may then radiate to other parts of the head, including the face, neck, and shoulders.

Pain may be present in a temple or a cheek. It remains on one side of the head. The individual may pace around during the episodes of pain, unable to stay still for long. If they do sit down, many may rock back and forth in an attempt to sooth the discomfort. Each cluster can last from 15 minutes up to several hours, but not usually more than an hour. One to three clusters may occur each day.

Research has found that during an attack there is more activity in the hypothalamus, an area of the brain that controls body temperature, hunger, and thirst. It may be that this area of the brain releases chemicals that cause blood vessels to widen, resulting in a greater blood flow to the brain. This may cause the headaches. Why this would happen is a mystery, but it is true that alcohol, a sudden rise in temperature, or exercising in hot weather may trigger attacks.

The cyclical nature of cluster headaches suggests that they may be linked to the biological clock, which is located in the hypothalamus. Researchers have found that people who have cluster headaches often have unusual levels of melatonin and cortisol during an attack. Apart from alcohol, cluster headaches are not linked to the consumption of any foods, and they have not been linked to mental stress or anxiety.

Alcohol only acts as a trigger if a person is in the middle of a cluster period. There may be a link between cluster headaches and some medications, such as nitroglycerin, which is used for the treatment of heart disease. In northern countries, attacks tend to be more frequent during the fall and spring. Extreme variations in temperature can trigger an episode during an attack.

The change in temperature is often linked to a rapid rise in body temperature. Since the causes of cluster headaches remain unclear, there are no proven lifestyle measures for preventing them. Between 10 and 20 percent of people develop a resistance to the drugs that are normally used to treat cluster headaches.

Cluster headaches can cause disruption to the daily routine, and this can lead to stress and depression. A counselor may help develop coping strategies.

Cluster headaches and migraines are both severe forms of headache, but they are different and need different treatment. A migraine can last for up to 72 hours, and it commonly involves nausea, vomiting, and sensitivity to light. A cluster headache starts and ends suddenly and it lasts a shorter time. It often features congestion, watery eyes, and a runny nose. Other treatments may be considered if verapamil is not effective. These may include corticosteroids , lithium medicine and local anaesthetic injections into the back of the head occipital nerve blocks.

You may need to try a few different treatments before your attacks are brought under control. Living with cluster headaches can be very difficult, particularly if you have long-term chronic cluster headaches. The number is You can also contact them by email: info ouchuk. Page last reviewed: 01 May Next review due: 01 May Cluster headaches. Symptoms of a cluster headache Cluster headaches begin quickly and without warning.

You may also get 1 or more of the following symptoms: a red and watering eye drooping and swelling of 1 eyelid a smaller pupil in 1 eye a sweaty face a blocked or runny nostril The attacks generally last between 15 minutes and 3 hours, and typically occur between 1 and 8 times a day. What causes cluster headaches? People who smoke seem to have a higher risk of getting cluster headaches.

Pattern of attacks Cluster headaches usually happen every day, in bouts lasting several weeks or months at a time typically 4 to 12 weeks , before they subside.

When to get medical advice You should see a GP as soon as possible the first time you experience what you think may be a cluster headache. They'll ask you about your symptoms and may refer you for tests. Treatments for cluster headaches Cluster headaches are not life threatening, but they can cause severe pain and significantly affect your quality of life. Instead, you'll need to have one or more specialist treatments. These are: sumatriptan injections — which you can give yourself up to twice a day sumatriptan or zolmitriptan nasal spray — which can be used if you do not want to have injections oxygen therapy — where you breathe pure oxygen through a face mask These treatments usually relieve the pain of a cluster headache within 15 to 30 minutes.

Transcutaneous vagus nerve stimulation Transcutaneous vagus nerve stimulation TVNS is a fairly new treatment that uses low-voltage electrical currents to stimulate a nerve in the neck. The aim is to relieve pain and reduce the number of cluster headaches.

Stimulation device implantation If you've had cluster headaches for a long time and other treatments have not worked, surgery to implant a stimulation device may be recommended. Preventing cluster headaches Avoiding triggers Avoiding the triggers of cluster headaches can help prevent them. For example, you should not drink alcohol during a cluster headache bout. Medicines Your doctor may prescribe medicine to prevent cluster headaches during a bout.

Preventative treatments can vary in effectiveness from person to person.