United Kingdom
Change

Support and offers for individual members and customers

Health Information

Cluster headache

Published by Bupa's health information team, December 2007.

This factsheet is for people who have cluster headaches or who would like information about them.

Cluster headaches are severe headaches that typically affect the area around one eye or the temple (the flat areas on the side of your forehead). Headaches are a common symptom of many conditions.

This factsheet doesn't discuss tension-type headache, medication-overuse headache, migraine or headache that is caused by illness or injury. For more information on these, please see Related topics.

About cluster headaches
Symptoms
Causes
Diagnosis
Treatment
Prevention
Living with cluster headaches
Further information
Questions and answers
Related topics
Sources

About cluster headaches

Around one in 250 people get cluster headaches. They are about twice as common in men than in women, and usually start between the ages of 20 and 40.

Cluster headaches occur in bouts. During a bout, you will get a headache at least once every two days and up to eight times per day. This is usually on the same side of your head. Bouts of cluster headaches last for weeks or months and may happen annually at around the same time of year.

Some people have remission periods, where the headaches stop for months or years. This pattern is called episodic cluster headache. But around one in 10 people who get cluster headaches don't have remission periods. This is called chronic cluster headache.

Symptoms

Cluster headaches last between 15 minutes and three hours. They cause excruciating pain around one eye or temple, which can spread further around the head. People often describe the pain as "burning" or "boring". The pain usually comes on quickly, often reaching its peak within five to 10 minutes. It remains at this intense level for the rest of the attack and then stops suddenly.

You may also have one or more of the following symptoms on the same side when you have a headache:

reddened, watering eye
runny or blocked nose
swollen eyelid
sweating
drooping eyelid
small pupil

Cluster headaches tend to start at the same time each day, often at night, waking you up around one or two hours after going to sleep. Cluster headaches make you agitated. You may feel you can't lie down any more and want to pace around. You may feel very frustrated with the pain.

Causes

No-one knows why some people get cluster headaches and others don't. They may be caused by over-activity in a part of the brain called the hypothalamus. This part of the brain controls the body's daily rhythm, which may explain why the headaches happen at regular times.

Some people may inherit the condition. One in 20 people who get cluster headaches has a close family member who is also affected.

Alcohol may bring on a headache during a cluster bout. Other possible triggers include exercising, hot rooms, hot baths or strong smelling substances like petrol, perfume or solvents.

Diagnosis

Your GP will ask you questions about your symptoms and family history. He or she will carry out a physical examination and may refer you to a neurologist - a doctor who specialises in conditions that affect the nervous system. There is no specific test or investigation to diagnose cluster headaches.

You should see a doctor or visit a hospital if:

you get a sudden, severe headache unlike any you have had before.
the pain is worst upon waking
your headache follows a head injury

You should also see a doctor if you have a headache accompanied by any of the following symptoms:

stiff neck
fever and rash
confusion
paralysis, numbness, changes to your vision, slurred speech or behaviour changes

Treatment

Your GP may refer you to a neurologist or a specialist in a pain clinic for treatment.

Normal painkillers don't work for cluster headaches. However, an injection of a painkiller called sumatriptan stops three quarters of attacks within 15 minutes. Your doctor will show you how to give yourself the injections in your thigh or stomach when you need them.

A nasal spray of sumatriptan may help some people and is increasingly used as the first treatment.

Breathing pure oxygen for around 15 minutes may relieve the headache. If your doctor prescribes oxygen, you can arrange to get oxygen cylinders for use at home.

Prevention

You shouldn't drink any alcohol during a bout because this brings a headache on in many people. Also avoid any other triggers that you have noticed, such as exercise, hot rooms, hot baths or strong smells.

There are some treatments that may prevent or reduce cluster headaches. However, there is no strong medical evidence to say which work best and what dose you should take, and these medicines are not licensed for cluster headaches. Speak to your neurologist or pain specialist about them.

Some examples include:

corticosteroids - a short course of corticosteroid tablets at the start of a bout may help
verapamil - this medicine is usually used for angina, but can stop two thirds of cluster headaches
ergotamine - this painkiller is usually used for migraines, but it can stop cluster headaches if taken 30 minutes to two hours before one is due; you should not take it for long periods
methysergide - another painkiller used for migraines, this can cause side-effects such as nausea, vomiting, dizziness and drowsiness, so is only used if other treatments haven't worked
lithium - usually used for treating bipolar depression (previously known as manic depression), this can help with chronic cluster headache

You will usually need to have regular check ups with your doctor so he or she can monitor your treatments.

Living with cluster headaches

Although treating your headaches can help to control them, they can still interfere with your life. During a bout you may feel tired because the headaches wake you up at night. You might find it difficult having to give yourself frequent injections or to use an oxygen cylinder. Many people feel it helps to talk to others who get cluster headaches and to share their experiences. The contact details of a charity for people who suffer from cluster headache are given below.

Further information

OUCH (UK) - Organisation for the Understanding of Cluster Headache
01646 651979
www.ouchuk.org