Cluster Headache

A cluster headache is different from a migraine or a tension headache. It's also much less common. A cluster headache starts suddenly, without any warning. The pain can become severe within minutes. The headache is often brief. It can last only 15 minutes. But it can also continue for several hours.

The pain is around a single eye. You may have tears coming from that eye. That eyelid may become droopy. The eye may be red and swollen. You may also have a stuffy or runny nose on the affected side.

You may also have several headaches in one 24-hour period. These may return at the same time of day during the cluster period. A cluster headache ends as suddenly as it began. It often leaves you feeling exhausted for some time afterward.

Cluster headaches often occur at night and during certain times of the year that are unique to you. A cluster period ranges from a few weeks up to a few months. Then, the headaches may not come back for months or years.

Possible triggers include alcohol and smoking. Even a single alcoholic drink can trigger a headache during the cluster period. Another potential trigger is interrupted sleep patterns. Medicines like nitroglycerin can also cause a cluster headache. Cluster headache affects men more than women.

Treatment for cluster headaches varies. Headaches that last only 15 minutes aren’t helped by over-the-counter medicines. That’s because these medicines take 20 to 30 minutes to start working. Prescription medicines given by injection or as a nasal spray can stop a headache. This is called abortive treatment.

Preventive medicines include steroids, anti-seizure medicines, and certain blood pressure medicines. These can help cut the number of headaches you have during a cluster period. A newer medicine that requires a monthly injection (galcanezumab) can also reduce the number of attacks. High-dose oxygen therapy or a nerve stimulator may shorten each attack and make it less severe. If you have cluster headaches often or have severe symptoms, your healthcare provider may talk with you about surgery. Surgery such as deep brain stimulation may be able to stop the nerve that’s sending the pain signals. These types of treatments are usually given by a specialist (neurologist or neurosurgeon). They are considered experimental.

Home care

Follow these tips when caring for yourself at home:

  • Don’t drive yourself home if you were given pain medicine for your headache. Instead, have someone else drive you home. Try to sleep when you get home. You should feel much better when you wake up.

  • If your healthcare provider gave you preventive medicines, take them as directed. If abortive medicines were prescribed, carry these with you to take at the first sign of a headache.

  • Stick to a regular sleep schedule. Avoid afternoon naps during a cluster period. If you have sleep apnea, talk with your provider about getting treatment for this condition. Sleep apnea greatly interferes with sleep patterns.

  • Stay away from gas fumes and oil-based paint fumes. You may know other triggers to stay away from.

  • Don't drink alcohol or smoke during a cluster period.

  • Be cautious when traveling to high altitudes. Higher altitudes have less oxygen. This may trigger a headache.

  • Use sunglasses to avoid glare and bright lights.

  • Keep a headache journal. Record the date and time of each headache. Describe the quality of the pain. Note how severe it is, where it is, and how long it lasts. Write down your response to any medicines to control the pain. Note possible triggers: Was it something you ate? Something you did just before the attack? Share this information with your provider to help them figure out the best treatment plan for you.

  • Talk with a counselor or therapist, or join a support group. This may help you cope with the effects of cluster headache on your life.

Follow-up care

Follow up with your healthcare provider, or as advised. If you had a CT scan or an MRI, a specialist will review it. You will be told of any new findings that may affect your care.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Unexplained fever greater than 100.0ºF (37.8ºC), or as advised by your provider

  • Stiff neck or rash

  • Headaches brought on by physical activity

  • You need to use more pain medicine than normal

Call 911

Call 911 or get immediate medical care if any of the following occur:

  • Sudden, severe headache, worse than any you have had before

  • Headache with a fainting spell

  • Weakness in an arm or leg, or on one side of your face

  • Trouble speaking

  • Changes in your vision

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