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NeurologicalICD-10: G44.009Affects approximately 1 in 1,000 people

Cluster Headaches

Also known as: Cluster Head Pain, Suicide Headache, Histamine Headache

Cluster headaches are one of the most painful types of headache, characterized by severe, piercing pain on one side of the head, typically around or behind the eye, occurring in cyclical patterns or clusters lasting weeks to months. Attacks often happen at the same time each day, frequently waking sufferers from sleep, and are accompanied by tearing, nasal congestion, and restlessness. Unlike migraines, cluster headaches are more common in men and have a distinctive pattern of remission periods followed by active cluster periods.

Symptoms

Excruciating, sharp, or burning pain on one side of the head, usually around the eye
Tearing or redness of the eye on the affected side
Nasal congestion or runny nose on the affected side
Drooping eyelid (ptosis) or constricted pupil (miosis) on the affected side
Facial sweating on the affected side
Restlessness and agitation during attacks
Attacks lasting 15 minutes to 3 hours
Swelling around the eye on the affected side

Causes

  • Abnormalities in the hypothalamus regulating the body's biological clock
  • Dilation of blood vessels supplying the brain and face
  • Activation of the trigeminal nerve pathway
  • Dysregulation of serotonin and histamine levels

Risk Factors

  • Male sex (3-4 times more common in men)
  • Age between 20 and 50 years
  • Smoking or history of heavy smoking
  • Alcohol consumption during cluster periods
  • Family history of cluster headaches

Diagnosis

  • Clinical diagnosis based on headache pattern, location, and associated symptoms
  • MRI or CT scan to rule out other causes of severe headache
  • Neurological examination to assess cranial nerve function
  • Headache diary documenting frequency, duration, and triggers

Treatment

  • High-flow oxygen therapy (100% oxygen at 12-15 L/min) for acute attacks
  • Sumatriptan injection or nasal spray for rapid relief
  • Verapamil as a first-line preventive medication
  • Corticosteroid bridge therapy (prednisone) for short-term prevention
  • Galcanezumab (Emgality) injections for episodic cluster headaches
  • Occipital nerve blocks for refractory cases

Prevention

  • Avoid alcohol during cluster periods as it can trigger attacks
  • Maintain a consistent sleep schedule
  • Take preventive medications as prescribed before and during cluster periods
  • Avoid strong smells, solvents, and other known triggers
  • Consider melatonin supplementation under medical guidance

When to See a Doctor

  • You experience severe, one-sided headaches that occur in patterns
  • Headache pain is sudden, severe, and unlike any previous headache
  • Current treatments are no longer effective in managing attacks
  • Headaches are accompanied by fever, vision changes, or neurological symptoms

Frequently Asked Questions

Related Conditions

Migraine

Neurological

Insomnia

Mental Health

Depression

Mental Health

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.