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Cluster headaches

Cluster headaches are severe headaches that only occur on one side of your head, usually around or behind your eye or temple. Your temple is the flat part of your head at the side of your forehead.

About two in 1,000 people get cluster headaches in the UK, which makes them a rare type of headache. Cluster headaches are more common in men – between three and seven times more men get cluster headaches than women.

Cluster headaches can occur in bouts – ‘clusters’ – up to eight times a day over many weeks or months. After about six to 12 weeks of having a regular pattern of cluster headaches, you may have remission periods when you have no headaches. These can last weeks or months. If you have these remission periods between bouts of cluster headaches, they will often occur at certain times of the year. The pattern is referred to as episodic cluster headache.

You may have a continuous, mild, background headache between the more severe attacks of pain. Around two in 10 people with cluster headaches have no remission periods over the course of a year and have what's called chronic cluster headaches.

Most people who get cluster headaches are in their 20s or older. Once you start having them you’re likely to have bouts for the rest of your life – particularly if you have chronic cluster headaches. However, if you have episodic cluster headaches, the periods between attacks often become longer as you get older.

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Details

  • Symptoms Symptoms of cluster headaches

    If you have cluster headaches, you will have a very severe pain on one side of your head. You will usually feel this pain around or behind your eye or around your temple. You may have other symptoms on the same side as the pain, such as:

    • a red or watering eye
    • a constricted pupil in your eye
    • a drooping eyelid (ptosis)
    • a swollen eyelid
    • a runny or congested nose
    • sweating or flushing on your face or forehead

    You may also have symptoms similar to those of a migraine, although this is uncommon. These include:

    • sensitivity to light
    • sensitivity to noise
    • feeling sick or vomiting

    Often, cluster headaches will wake you up within a couple of hours of going to sleep but you can get them at other times. A cluster headache can last anything from 15 minutes to three hours. You may feel restless and pace about.

    If you have any of these symptoms, see your GP.

  • Diagnosis Diagnosis of cluster headaches

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP will ask you about how often the pain happens and when it occurs. Therefore, you may find it useful to keep a headache diary for a couple of weeks before you visit your GP. When you get a headache, things to record include:

    • its severity
    • how long it lasts
    • any other symptoms
    • whether you took any painkillers (and if these worked)

    This can help to get the right diagnosis. Your GP may also take your blood pressure to rule out other conditions.

    If your GP thinks you have cluster headaches, he or she may refer you to a neurologist. This is a doctor who specialises in identifying and treating conditions that affect the nervous system (including the brain). Your neurologist may suggest you have an MRI scan.

  • Treatment Treatment of cluster headaches

    There isn't a cure for cluster headaches. However, there are various treatments that aim to reduce the severity of your cluster headaches and shorten the length of each bout. There are also medicines to prevent them from starting (see Prevention).

    Cluster headaches are very unlikely to get better if you take over-the-counter painkillers, such as paracetamol or ibuprofen. If you have cluster headaches, you will need a prescription for other types of medicine.

    Medicines

    A type of medicine called sumatriptan has been found to be effective for cluster headaches. You usually have this medicine as an injection. A nurse will show you how to do this so you can give it to yourself). A nasal spray is available too.

    Sumatriptan isn't suitable for you if you’re pregnant or breastfeeding, or have a heart condition, such as coronary artery disease or high blood pressure.

    There are a number of side-effects that you may get with sumatriptan. These include sensations of tingling, heat, heaviness, pressure or tightness in any part of your body.

    If sumatriptan isn't suitable for you, another option is a medicine called zolmitriptan that comes as a nasal spray. However, it takes slightly longer to have an effect than sumatriptan injections.

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Oxygen

    You might find it helps to breathe pure oxygen from an oxygen cylinder to relieve your symptoms quickly, and this has few side-effects. Your GP can prescribe oxygen for you if your neurologist recommends it. You can have oxygen treatment at home as many times a day as you need. You will need a high-flow system so that the oxygen concentration you inhale is 100 percent, as lower concentrations won’t usually help.

  • Private GP appointments

    With our GP services, we aim to give you an appointment the next day, subject to availability. Find out more today.

  • Causes Causes of cluster headaches

    The exact reasons why you may get cluster headaches aren’t fully understood at present. However, you’re more likely to develop them if you:

    • have a close relative with the condition, as cluster headaches may run in families
    • smoke, although it’s not clear if stopping smoking has a positive effect on cluster headaches
    • have had a previous serious head injury (although there is often a long time delay between the injury and the start of the headaches)

    There is some evidence to suggest that the hypothalamus is involved in regulating the predictable pattern of cluster headaches. The hypothalamus is part of the brain that controls your body's daily rhythms and has an effect on mood, appetite and sleep.

    Some things may trigger cluster headaches, but usually only when you’re going through a bout of getting them. In remission periods they may not have the same effect. Triggers include:

    • drinking alcohol
    • being exposed to strong smells such as petrol, paint fumes, cigarette smoke and perfume
    • becoming overheated, for example after a hot bath or exercise
  • Prevention Prevention of cluster headaches

    Self-help

    If you’re having a bout of cluster headaches, aim to avoid anything you have identified that may trigger an attack. These triggers might include drinking alcohol or exposure to strong smells, such as petrol.

    Medicines

    There are a number of different medicines your doctor can prescribe to help prevent cluster headaches. The most common medicines include verapamil and lithium. You may find some medicines more effective than others and may need to try different ones to find out the best result. There are side-effects to some of these medicines so your doctor will monitor you to ensure you can take them safely.

    Your doctor may recommend you take steroid medicines for a short period of time too. These may help to reduce the severity and duration of cluster headache bouts and give preventative medicines a chance to have an effect.

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    There have been a number of small studies that show that a technique called occipital nerve stimulation is effective for preventing chronic cluster headaches. This involves inserting a tiny device into the back of your scalp to stimulate the greater occipital nerve that’s involved in causing the headaches. This is only available in specialist centres and more medical trials of this technique are needed to find out how safe and effective it is.

    If you get chronic cluster headaches and other treatments haven’t worked, you may be offered a type of brain surgery called deep brain stimulation. However, this is usually only considered as a last resort because of the serious risk of complications that can occur.

  • Living with cluster headaches Living with cluster headaches

    The severity of pain from cluster headaches can make them difficult to live with. Follow the treatment plan from your doctor and return for further advice if necessary as this can help to keep your cluster headaches under control. Get to know your triggers and take steps to avoid these.

    Ask for support from your family and friends, who may be able to help with everyday tasks when your pain is particularly severe. There are also self-help groups that you can join to meet other people who have the same condition.

  • FAQs FAQs

    What is the difference between a cluster headache, a migraine and a tension headache?

    Cluster headaches, migraines and tension headaches can be confused with one another. However, there are key features that can be used to tell them apart and help with your diagnosis. It’s important to get the right diagnosis because treatment options are different for each headache type.

    If you have cluster headaches, you will have severe pain on one side of your head. You may have other symptoms too, such as a watering eye on the side of your headache or a drooping eyelid. You may feel agitated and want to move about. You may also notice that you get the headaches at certain times of the day. Over-the-counter painkillers won't usually help with cluster headaches. Your doctor will need to prescribe you other medicines, such as triptans or oxygen therapy.

    Migraines usually cause severe pain on one side of your head, like cluster headaches. However, you’re much more likely to also have other symptoms, including feeling sick or vomiting and being sensitive to light or sound. You’re also more likely to get problems with your vision with a migraine than with other headache types. These can include seeing moving patterns of colours or flashing lights. If you have a migraine, you will probably want to lie down and sleep. Migraines can be treated with over-the-counter painkillers but you may need a prescription for triptans or non-steroidal anti-inflammatory drugs (NSAIDS).

    Tension headaches are far more common than migraines or cluster headaches. They usually cause less severe pain on both sides of your head and you may have a tightening sensation. They are likely to get better if you take over-the-counter painkillers, such as paracetamol or ibuprofen.

    If you’re going to see your GP about your headaches, keep a headache diary in the weeks before you visit. This can be a useful tool to help with diagnosis.

    Is there any way of knowing when a cluster headache is about to start?

    Cluster headaches usually come on quickly, but you may have some signs just before the headache starts.

    Some people get signs that a headache is about to start. For example, you may feel sick or vomit, or be sensitive to light or sound. The main way to predict a cluster headache starting is being aware of what time of day and at what time of year they usually begin. Most people find that their cluster headaches follow a predictable pattern, which you can track if you keep a headache diary.

    Will I always get cluster headaches?

    The frequency, timing and severity of cluster headaches may change as you get older. If you get episodic cluster headaches, the periods between attacks often become longer as you get older. However, if you have chronic cluster headaches, they tend to last throughout your life.

    There is no way to predict how a cluster headache pattern may change as time goes on. Most people find that remission periods get longer as they age and the episodic cluster headache settles down. However, occasionally, the bouts get longer with shorter remission periods. For these people, episodic cluster headaches may then become the chronic, more persistent form.

  • Resources Resources

    Further information

    • OUCH (UK) - Organisation for the Understanding of Cluster Headache UK
      01646 651 979
      www.ouchuk.org

    Sources

    • Cluster headache. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 9 February 2010
    • Headache – cluster. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2012
    • Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type headache, cluster headache, medication-overuse headache. British Association for the Study of Headache. www.bash.org.uk, published September 2010
    • Map of Medicine. Headache in adults. International View. London: Map of Medicine; 2013 (Issue 1)
    • Matharu M, Goadsby P. Update on a common neurological problem – cluster headache. Pract Neurol 2001; 1:42–49. doi:10.1046/j.1474-7766.2001.00505.x
    • Cluster headache. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
    • Headaches. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published September 2012
    • Cluster headache. Medscape. www.emedicine.medscape.com, published 18 October 2012
    • Hypothalamus anatomy. Medscape. www.emedicine.medscape.com, published 28 January 2013
    • Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database of Systematic Reviews 2013, Issue 7. doi:10.1002/14651858.CD008042.pub3
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 12 March 2014
    • Occipital nerve stimulation. Medscape. www.emedicine.medscape.com, published 21 March 2013
    • Migraine headache. Medscape. www.emedicine.medscape.com, published 23 December 2013
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