Cluster Headaches – Excruciating Attacks of Headaches

Danger level: Medium

What is it?

Cluster headache is a type of headache (we recently covered here migraine type headaches) that occurs repeatedly for weeks to months, followed by periods with no headache.

Who gets it?

It’s estimated that 0.4% of men and 0.08% of women experience this type of headache (it’s 5 times more common in men). It typically begins appearing at ages 20-40.

What causes it?

There are 12 nerves that originate in the brain stem and that go to other parts of our head. These nerves are called the cranial nerves.

One of these nerves – the 5th, which is called the trigeminal nerve – is responsible for sensations (such as heat or pain) in our face.


The trigeminal nerve – it’s responsible for the pain in cluster headaches

In cluster headaches, that nerve is activated, causing pain without reason.

That nerve also stimulates other nerves, which cause eye tearing and redness, nasal congestion and discharge. This explains the other symptoms in cluster headaches (as you’ll see ahead).

Why is the trigeminal nerve suddenly activated? It’s believed that this is a result of a dilatation of blood vessels, which create pressure on the nerve.

How does it feel?

While the explanation above is all scientific and nice, it doesn’t illustrate the severity of the pain – the pain in cluster headaches is deep, excruciating, continuous and explosive. It begins without any warning (as opposed to the aura in migraine headaches) and reaches a peak within minutes. The pain is so intense that people can’t sit still and go pacing during an attack. The pain is almost always one-sided.

The pain in cluster headaches is usually behind the eye, or near the eye. It usually lasts from 15 minutes to 3 hours.

So why are these headaches called cluster headaches? Because they come

in clusters, or groups – most people will experience a few attacks each day (up to 8 times a day!), usually during the same times each day. Those attacks usually last over a period of 4-8 weeks, after which there’s a pain-free interval of six months to a year (or more).

Remember that the trigeminal nerve can also cause tearing and nasal congestion? This is why along with the pain can come eye redness and tear production on the side of the pain and a runny nose.

This video demonstrates a typical episode of a cluster headache (sorry for the poor guy who serves as an example…):

How is it treated?

There are drugs used here that can do one of two things:

  1. Stop the attacks – These include injection of a drug called sumatriptan (which is also used in migraine headaches). Another option is breathing oxygen through a face mask for 20 minutes. There are also other types of drugs that might work here.
  2. Prevent the attacks – These can shorten the length of the headache period and decrease the severity of attacks. There are many drugs that may be used here.

As well as medications, a surgery can also be performed, which is meant for people for whom medications didn’t help. In the surgery the trigeminal nerve is operated on.

What happens after treatment?

Generally, cluster headaches are a life-long problem. In about 10% of people the episodes might turn into a chronic condition, which does not have a month worth of a pain-free period. The drugs can help turn back the chronic condition to an episodic one, but they don’t make the condition go away.

The bottom line – How do I avoid it?

Cluster headaches are more common in people who smoke and drink alcohol frequently, so stopping smoking and drinking less alcohol might prevent it if you’re prone to it.

Also taking any of the drugs which are meant for prevention might help.


Have you suffered from cluster headaches or know anyone who does? Share your story in the comments.

Category : Brain