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Cluster headaches

Written by Healthwords's team of doctors and pharmacists based in UK | Updated: 24.02.2023 | 3 min read

Cluster headaches are terrible attacks of pain that affect one side of the head, usually around the eye. The cause for them is not completely clear, but it does have a tendency to run in families and occurs more in people that smoke. They are not very common but can affect anyone. Cluster headaches usually occur in clusters, occurring every day around the same time, for several weeks at a time, before they stop. They can recur yearly and can be lifelong. They can be triggered by things such as alcohol and even strong smells. 

What are the symptoms?

Cluster headaches occur in attacks and come on quickly. The attacks usually last for between 15 minutes and several hours and can happen multiple times a day. They are very severe, intense sharp pains on one side of the head or face. Commonly it happens around the eyes, causing pain behind the eye, and the eye can water and look bloodshot, or the pupil can look constricted (small). You may also experience a blocked or runny nose and occasionally sweating.

When should I see my doctor?

If this is the first time you have ever experienced something like this, this pain can be very intense and feel quite frightening. You should speak to your doctor, who will take a history from you and may refer you for further tests. A brain scan is not needed to diagnose a cluster headache as it will be normal, but a scan may be used to rule out any other serious causes of your symptoms. Your doctor may try you on some treatment to begin with, but often they need to refer you to a brain specialist (neurologist) for further management.

How is it treated?

Simple painkillers like acetaminophen and ibuprofen are not usually very effective for treating cluster headaches. The symptoms of cluster headaches can be very debilitating and affect your ability to function when the attacks happen. If you've already been diagnosed, it may be worthwhile letting your employer know in advance so that they can make the necessary provisions. 

Your doctor may be able to prescribe you a medication to take as soon as an attack starts. A common drug is a sumatriptan, which can be taken as an injection just underneath the skin or as a nasal spray. It's a drug that acts fast to reduce your symptoms within 30 minutes – it's not a painkiller as such, but it targets cluster headaches. Sumatriptan and other triptans also target migraines, and for this, they can be given as an injection, nasal spray, or tablet, but tablet form is not effective for cluster headaches.

Continuous inhalation of oxygen for 20 minutes using a mask without holes is also said to provide fast-acting pain relief. 

Transcutaneous vagus nerve stimulation uses a low-dose electrical current to stimulate the nerves in your neck. They can be used for attacks and before attacks to prevent them. This is only available via a specialist.

Can I prevent them from happening?

The most important thing you can do is try to identify any triggers that may cause your symptoms and avoid them. For some, this may be to avoid alcohol, and for others, avoid strong smells such as paint or perfume. Cluster headaches are more common in those who smoke, so it is advised to quit smoking. 

Your neurologist may consider starting you on regular medication to help prevent cluster headaches from happening in the first place. These have varying success rates. Examples of such medications include verapamil and steroids, but these medications come with side effects, so it is best to consider all options thoroughly before starting. 

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