Cluster Headache

Cluster Headache
Body Parts: Head
Medical Subjects: Nervous System

What Is Cluster Headache?

Headache is one of the most common disease symptoms. Headache caused by other diseases is called "secondary headache". Headache for which no specific cause can be found is called primary headache. Primary headache is classified again according to the characteristics of headache. Cluster headache is one of the primary headaches.

Cluster headache has the following characteristics:

  • It is clustered, that is, the headache does not occur after repeated concentrated attacks, but continues to occur after a period of time, and so on. Headache period is called cluster period, while non-attack period is called intermittent period.
  • Headache mostly concentrated around the orbit, almost all of them are unilateral. Alternate left and right and bilateral seizures are rare.
  • Each headache can last from 15 minutes to 3 hours (without medication).
  • The headache is accompanied by ipsilateral tearing, conjunctival congestion, nasal congestion, runny nose or nervousness, restlessness and other symptoms.

Is cluster headache common?

Unusual. The prevalence of cluster headache is <0.1%. But some countries' data may be higher than this. Cluster headache is a relatively rare primary headache disease.


What Is The Cause Of Cluster Headache?

Who are cluster headaches common?

Cluster headache is more common in young people between 20 and 40 years old. The incidence rate in men is 4 to 5 times that of women, and there is generally no family history.

Are there any triggers for cluster headache attacks?

Cluster headaches can be induced by the following factors and should be avoided as much as possible:

  • Life is irregular.
  • Drinking.
  • Hypoxia, especially in patients with sleep apnea syndrome.
  • Take drugs such as nitroglycerin.

Why do patients with cluster headaches can't open their eyes and drooping eyelids?

The etiology of cluster headache is the dysfunction of two neural pathways. One was an abnormal trigeminal neurovascular pathway, causing headache. The other one is the abnormality of autonomic nerve pathway (including sympathetic and parasympathetic nerve fibers), which causes some accompanying symptoms of headache, such as lacrimation, conjunctival congestion, nasal obstruction and nasal discharge.

Impairment of the sympathetic nerve that innervates the upper eyelid muscles can lead to ptosis, and the patient may also have ipsilateral ocular fissure, sunken eyeball, and miosis.


What Are The Symptoms Of Cluster Headache?

Why is cluster headache called "suicidal headache"?

The headache can be very severe during cluster headache attacks, and the patients are often unbearable, so it is also called "suicidal headache". Compared with tension-type headache and migraine, cluster headache is the most serious headache.

Why is cluster headache called "alarm headache"?

Cluster headache, also known as "alarm clock headache", is due to its relatively fixed attack time. Mainly reflected in two aspects:

  • Headache often occurs at a certain time every day, and it is more common in the afternoon and night.
  • Some patients often attack in a particular season of the year, such as spring and autumn.

Studies believe that the hypothalamus plays a key role in initiating cluster headaches. The periodic appearance of headaches may be related to the suprachiasmatic nucleus, which controls the regular movement of human body day and night.

What are the accompanying symptoms of cluster headache?

  • Eye symptoms: for example, swollen eyelids, drooping eyelids, conjunctival congestion, tears, and miosis.
  • Nasal symptoms: such as stuffy nose and runny nose.
  • Forehead or facial symptoms: such as sweating and flushing on the forehead or face.
  • Ear symptoms: such as fullness.
  • Emotional change: restlessness or agitation.

People with cluster headaches may inevitably experience some mood swings. If you suffer from cluster headaches, while relieving symptoms, you can improve your mood through lifestyles such as meditation and exercise, or get out of emotional dilemmas with psychological counseling. If someone around you suffers from cluster headaches, please give them understanding and care.


How To Check If You Have Cluster Headache?

Can cluster headache be diagnosed by myself?

Generally speaking, patients cannot judge by themselves.

If headache or severe headache occurs repeatedly, consult a doctor. According to the inquiry, the doctor decides whether to do some tests to rule out the possibility of secondary headache. If the examination is normal, it is necessary to judge which kind of primary headache it is according to the characteristics of headache, and then it can be treated symptomatic.

It is not advisable for many patients to take painkillers by themselves or repeatedly ask doctors to do various examinations when they have headaches.

What checks should be done for cluster headaches?

Clinically, for rare headaches (prevalence <1%), relevant examinations must be performed to rule out secondary causes. A variety of intracranial organic diseases such as tumors, inflammation, multiple sclerosis, and vascular diseases can have manifestations similar to cluster headaches. Therefore, patients with cluster headaches need to undergo head CT or MRI to exclude these diseases.

What are the types of cluster headaches?

There are two types of cluster headaches:

  • Episodic cluster headache: the interval of headache is more than one month.
  • Chronic cluster headache: the headache lasts more than one year or the remission period is less than one month.

Cluster headache and which headache diseases are similar?

Paroxysmal hemilateral headache, persistent hemilateral headache, and SUNCT (Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) are similar to cluster headache, but differ in presentation and require differentiation for proper treatment.

Paroxysmal unilateral headache

Paroxysmal unilateral headache is similar to cluster headache and is a rare primary headache. Compared with cluster headache, it has shorter attack time (usually lasting for 2–30 minutes each time) and more frequent occurrence (more than five times per day). If you use conventional anti-cluster headache treatment methods to treat it, the effect is not good. Treatment with Indomethacin is better.

Persistent unilateral headache

If there are paroxysmal migraine attacks every day for more than 3 months, it is called persistent migraine. Indomethacin treatment is effective.


The full name was "Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing", which had an ultrashort duration (average of 1 minute) and a higher frequency (average of 28 times per day). SUNCT syndrome is not effective for indomethacin and new antiepileptic drugs may be effective.


The full name is "Short-lasting unilateral neuralgiform headache with cranial autonomic symptoms", Compared with SUNCT, SUNA has only one or both symptoms of conjunctival congestion or tearing, and the treatment is similar.


How Do Patients With Cluster Headache Prevent Headache Attacks?

Avoid using sensitizing drugs. Do not eat spicy and pungent foods and fried foods. In addition, foods high in tyramine can induce headaches, such as chocolate, cheese, citrus, and alcoholic foods. Quit smoking and alcohol.


How Is Cluster Headache Treated?

How can the pain of cluster headache be relieved quickly when the headache strikes?

The onset of cluster headache is sudden and short-lived, and only those drugs or methods that can work quickly can be effective. Drugs that are effective for migraine attacks are often not effective for cluster headaches because they do not work quickly enough.

At present, the treatments that have been proven to stop cluster headaches are pure oxygen inhalation through the nose, inhalation of sumatriptan or zolmitriptan, and subcutaneous injection of sumatriptan.

Triptan is a specific analgesic drug that acts on the trigeminal neurovascular pathway. There is a large family of these drugs, including: zolmitriptan, sumatriptan, lizatriptan, naratriptan, amotreptan, frotreptan, and eliatriptan. Most drugs are oral preparations, and a few have subcutaneous injection and nasal spray.

How to use the medicine in the cluster phase of cluster headache?

The cluster phase of cluster headache requires daily medication until the headache disappears for at least 2 weeks and then gradually reduce the dose until the medication is stopped. Do not stop the medication suddenly. When the next clustering period comes, repeat the above operation.

The cluster phase medication is mainly preventive drugs, including ergotamine, verapamil, lithium carbonate, corticosteroids, mexiergot, and valproate (also called transitional therapy). These drugs help prevent the onset of headaches.

How to use the medicine during the intermittent period of cluster headache?

The intermittent period is a period of no symptoms. Except for the reduction of medication in the cluster period, no additional medication is required in the intermittent period. Therefore, for patients with a long intermittent period, there may be a relatively long drug blank period (that is, no medication is required).

Can cluster headaches be cured or cured on their own?

Cluster headache may have a long intermittent period (a period of no attack). Intermittent period does not require the use of additional medication, but this does not mean that it has been cured.

The cluster phase still needs to receive standardized transitional treatment to prevent the onset of headaches.

If the transitional medication is stopped without authorization or suddenly, part of the cluster headache may evolve into a chronic cluster headache, making the disease more difficult to treat.


What Should Patients With Cluster Headache Pay Attention To In Life?

Like other primary headache diseases, patients with cluster headaches should pay attention to the rationality of diet:

  • Avoid the use of sensitizing drugs. Do not eat spicy food and fried food. Foods with high tyramine content can easily induce headaches, such as chocolate, cheese, citrus, and alcoholic foods, avoid eating them.
  • Eat more cereals, legumes, and fresh fruits and vegetables that are rich in vitamin B1.
  • Quit smoking and alcohol.

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