From the Guidelines
Cluster headaches are characterized by severe, one-sided pain typically centered around or behind one eye, accompanied by autonomic symptoms, with the most recent and highest quality evidence suggesting that these headaches occur in cyclical patterns or clusters, with attacks lasting 15-180 minutes and occurring from once every other day to eight times daily during a cluster period 1.
Key Characteristics of Cluster Headaches
The pain is excruciating, often described as burning, piercing, or stabbing, and reaches peak intensity within minutes. Common accompanying symptoms include:
- Redness and tearing of the eye on the affected side
- Nasal congestion or runny nose
- Sweating on the forehead or face
- Eyelid drooping
- Restlessness or agitation Unlike migraine sufferers who prefer to lie down in dark rooms, cluster headache patients often pace or rock during attacks.
Diagnosis and Differential Diagnosis
Cluster headache is a much less prevalent primary headache disorder that affects ~0.1% of the general population, with features that are highly characteristic and include frequently recurrent but short-lasting attacks of strictly unilateral headache of severe or very severe intensity, accompanied by ipsilateral cranial autonomic symptoms, such as conjunctival injection, lacrimation, and nasal congestion 1.
Treatment and Management
High flow oxygen therapy (12 L/min via a non-rebreather mask) is recommended to treat acute attacks of cluster headache (CH) 1.
Prognosis and Quality of Life
The exact cause of cluster headaches remains unknown, but abnormalities in the hypothalamus and trigeminal nerve pathways are implicated, with triggers that may include alcohol, strong smells, high altitude, bright light, exertion, and certain medications 1. Men are more commonly affected than women, and onset typically occurs between ages 20-40.
From the Research
Signs and Symptoms of Cluster Headaches
- Cluster headaches (CH) are characterized by recurrent short-lasting attacks of excruciating unilateral periorbital pain, lasting 15 to 180 minutes, accompanied by ipsilateral autonomic signs such as lacrimation, nasal congestion, ptosis, miosis, lid edema, and redness of the eye 2, 3, 4, 5, 6
- The pain is strictly unilateral and can be orbital, supraorbital, temporal, or any combination of these 3
- Patients often experience restlessness or agitation during attacks, and may pace about 2, 4, 6
- Attacks can occur at precise hours, especially during the night, and may be triggered by alcohol, strong odors, or napping 2
- CH can be episodic or chronic, with episodic CH having remission periods, while chronic CH does not have significant remissions between cluster periods 2, 5
Associated Features
- CH has a circannual and circadian periodicity, with attacks being clustered in bouts that can occur during specific months of the year 2, 4, 6
- The disease is familial in about 10% of cases, and genetic factors play a role in CH susceptibility 2
- Involvement of the hypothalamus has been confirmed, explaining the cyclic aspects of CH 2