Do you get frequent headaches that are so painful they wake you up? Does the pain feel like a knife stabbing you in the eye or the side of the head? These headaches are so overwhelming they disrupt your life. If this sounds familiar, you may be experiencing a cluster headache attack.
There are more than 150 different types of headaches but not all are created equal. The most common types are migraines, tension headaches and cluster headaches. Each has unique symptoms and triggers but cluster headaches stand out for just how intense and painful they are.
“Cluster headaches are one of the most disabling primary headache disorders,” said Florin Tanase, MD, a neurologist with Banner – University Medicine. “Many people describe cluster headaches as one of the worst pains they have experienced.”
If you’re wondering whether your headaches could be cluster headaches, read on to learn the signs, causes and treatment options.
What is a cluster headache?
Cluster headaches occur in groups (clusters) over a period of weeks or months. During these cluster periods, the headaches happen often — sometimes several times a day. But then there are no attacks for months or even longer. In many people, the attacks awaken them from sleep at the same time every night.
“Cluster headache attacks can last between 15 minutes to 180 minutes and occur once every other day or even eight attacks a day,” Dr. Tanase said.
Cluster headaches are rare. Only about 0.1% of the global population (about one in 100,000 people) get them.
What do cluster headaches feel like?
Cluster headaches often happen on one side of the head, around the eye or temple. The pain is sharp, burning or stabbing. It can feel like something is poking you in the eye.
“People may also experience autonomic symptoms, like red or watery eyes, a droopy eyelid, swelling around the eye or a stuffy or runny nose,” Dr. Tanase said. “The attacks often occur on the same side of the head during a cluster period.”
Many people also experience agitation and become restless, unlike migraines where you need to be in a quiet, dark room and not move. During a cluster headache, you may be more likely to pace or sit and rock back and forth to try to feel better. However, like a migraine, some people with cluster headaches may also have nausea, vomiting and aura.
Common triggers to watch for
The exact cause of cluster headaches is not fully understood. However, experts believe it involves the hypothalamus, a part of your brain that controls your body clock.
Certain triggers can increase the chances of a cluster headache:
- Changes in seasons: Cluster headaches often occur in spring and fall.
- Alcohol: Drinking alcohol can trigger a headache.
- Strong smells: Perfumes, gasoline or smoke might bring one on.
- Smoking: People who smoke are at higher risk. However, quitting smoking may not stop the headaches.
- Lack of sleep: Sleep deprivation can be a common trigger.
- Exercise: Physical exertion or heavy exercise might increase the risk of an attack.
- Stress: High-stress levels or anxiety can trigger a headache.
How are cluster headaches diagnosed and treated?
There are currently no specific tests for cluster headaches. They are diagnosed based on your symptoms and physical exam. Your health care provider will ask about your pain, how often it happens and whether you’ve had other types of headaches. To rule out other causes, they may suggest imaging tests like an MRI or CT scan.
Treatment during an attack
“To stop a cluster headache when it strikes, your provider will use treatments that work fast,” Dr. Tanase said. “These treatments include inhaled oxygen and triptans like sumatriptan and zolmitriptan.”
- Oxygen: Oxygen therapy, where you breathe in pure oxygen through a mask, works for many people. Dr. Tanase said many people have great results with 100% oxygen at 12-15 liters on a non-rebreathing mask.
- Triptans: For medication, sumatriptan (taken as a shot or nasal spray) can reduce an attack's severity and length. If sumatriptan doesn’t work, zolmitriptan (a nasal spray) is another option.
Other treatments for acute attacks may include oral steroids, occipital nerve blocks or non-invasive vagus nerve stimulation.
Preventing future attacks
To reduce the frequency of attacks, your provider may prescribe preventive medications, such as:
- Verapamil (a blood pressure medication)
- Galcanezumab
- Lithium
- CGRP monoclonal antibodies
- Topiramate (an anti-seizure medication)
Other preventive options may include Botox injections, occipital nerve stimulation and radiofrequency ablation of the sphenopalatine ganglion. Avoiding known triggers like alcohol and getting quality sleep can also help.
What should you do if you think you have cluster headaches?
If you think you’re experiencing cluster headaches, don’t wait to get help. Start by seeing your health care provider or a headache specialist.
Here’s what you can do to prepare:
- Keep a headache diary: Write down your symptoms, when they happen and anything you think might trigger them.
- Be ready to share your medical history: Mention any family history of headaches or other conditions.
- Ask questions: Make a list of things you want to know more about, like what treatments are available and how to manage symptoms.
When to seek medical help
Cluster headaches, while extremely painful, are not life-threatening and they don’t cause physical damage to the brain. However, they can affect mental health. In fact, for some the headaches are so painful that they have reported experiencing suicidal thoughts.
“If you feel suicidal due to the severity of the pain, seek medical help immediately,” Dr. Tanase said. Call or text 988 the Suicide & Crisis Lifeline, call 911 or go to the nearest emergency department (ED).
You should also go to the ED if you have a sudden, severe headache with fever, confusion, stiff neck, numbness or weakness, loss of balance or vision changes.
See your health care provider if:
- Your headache pattern changes suddenly.
- Attacks are not controlled with prescribed medications.
- You don’t have access to oxygen during a severe attack.
Takeaway
If you experience severe, one-sided head pain with symptoms that come in clusters, you might be dealing with cluster headaches. Talk to a health care provider or a Banner Health specialist to explore your options for treatment and prevention.
