Cluster headaches are the most excruciatingly painful type of headaches. They are very different than your “average” migraine. Typical migraine headaches most commonly affect women. In contrast, cluster headaches are seen predominately in males. These headaches occur in groups, which may be daily for weeks to months. Rarely they continue for years. As compared to a migraine which may last 4-12 hours, cluster headaches are short lived, generally less than one hour. The character of cluster headache is different. These severe pain attacks occur on the same side of the head for every attack. They tend to be localized to the front of the head and around the eye on the affected side. Cluster headache is a syndrome with a constellation of various symptoms which can include eye redness, drooping eyelid, tearing, nasal congestion, facial sweating and flushing. It is important to note that these symptoms all occur on the same side as the headache attack.

In contrast to migraine suffers, who would rather lay down in a quiet dark room, individuals affected with a cluster attack are up pacing around, banging their head and generally cannot sit still. In my office it is not uncommon to hear the saying, “If I had a gun, I’d shoot myself because the pain would be less.” If a patient with headaches says this, the diagnosis is almost certainly cluster headache. This threat should not be taken lightly as unfortunately the incidence of suicide in cluster headache sufferers is higher than the general population. Because of the severity of these headaches, they must be treated aggressively from the time they start. A cluster headache patient may go weeks to months or years without an attack. When they do start, they usually become severe within a week or so. A person may have several attacks in a day. During these attacks, they are completely disabled. Alcohol will trigger a cluster attack during a siege but at other times, when the patient is not having headaches, alcoholic beverages have no effect.

From the onset of the cluster attack, these patients need intensive, aggressive therapy. In contrast to migraines where you have time to adjust medications, a cluster sufferer needs multiple, maximum treatment therapies started at the onset of a cluster. This can include oxygen for inhalation therapy. This will frequently abort an attack. The mainstay of therapy is prevention. Several different medications can be used to control cluster attacks from even occurring. These medications may include Prednisone, Depakote, Topamax, lithium, Verapamil, Lyrica, Sansert or Methergine. Not every medication works for every patient. It is important to see a headache specialist familiar with the aggressive treatment of cluster headaches. To relieve an acute attack, Imitrex injections work well. Although not designed to be used on a daily basis, some patients go outside of the prescribing guidelines to treat their clusters due to the severity of the pain. I instruct my patients that when they feel a cluster attack starting, they need to call for an immediate appointment so that we can get them started on aggressive maximum therapy as soon as possible. Patients suffering from cluster headaches should be under the care of a headache and migraine specialist due to the unique nature and treatment requirements of this disabling condition.


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