Cluster Headache

Cluster Headache

Cluster headache is another primary headache disorder that belongs to the class of trigeminal autonomic cephalalgias.  Although it is not as common as migraine it is certainly one of the most severe pain conditions known.  It affects approximately 1-2 people per 1000 population.  It can affect people of different ages, but unlike migraine, it tends to occur for the first time in middle age or even later.  We call these headaches cluster headaches because the headache attacks tend to occur in clusters or cycles during which patients may experience multiple attacks per day for a few weeks or even a couple of months.

What is causing cluster headache?

Cluster headache is another primary headache disorder, meaning that it is not being caused by a brain tumor, blood vessel abnormalities, infection, etc. It is now believed that cluster headaches at least in part occur due to dysfunction in a small part of the brain called the hypothalamus.  There is also some genetic predisposition to cluster headache as some studies suggested that the first degree relatives may have 5-18 times higher risk of cluster headaches than the general population.

How does cluster headache present?

Cluster headache typically presents as a strictly one-sided headache usually affecting one of the eyes, forehead, or temple.  The pain is usually described by the patient as being extremely severe, sharp, and stabbing and associated with tearing, redness of the eye, nasal congestion, or drooping eyelid on the painful side.  The attack typically lasts somewhere between 15 and 180 minutes at a time and can occur several times per day.  It frequently wakes patients up in the middle of the night.  The cluster cycle may last for a few weeks or a couple of months.  Cluster headache cycles tend to occur suddenly, without any obvious precipitating factors and may go away spontaneously as well.

How is cluster headache diagnosed?

Diagnosis of a cluster headache is clinical and depends on your history, the symptoms that you experience, and the findings on the physical and neurological examinations.  If necessary, we may perform certain blood tests or order neuroimaging (such as MRI or MRA of the brain). Yet the diagnosis remains a clinical one, based on the specific clinical presentation. 

That is why we spend time asking you questions, listening to your story, and examining you to better understand your symptoms and arrive at the correct diagnosis.

How is cluster headache treated?

There are specific acute or rescue medications we can use to alleviate a cluster headache attack.  These options may include oxygen, certain triptans, and non-steroidal inflammatory medications.  There are also prophylactic medications that may shorten the duration of a cluster headache cycle.  Recently FDA has approved Emgality - novel CGRP monoclonal antibody for the treatment of episodic cluster headaches. Other medication options may include corticosteroids, certain blood pressure, and antiseizure medications.  Some patients may also benefit from an interventional procedure such as SPG blocks, occipital or supraorbital nerve blocks, etc.