Cluster headache

Cluster headache is a primary headache disorder characterized by severe unilateral attacks of pain between the forehead and neck.


What are the causes of cluster headache?

The cause is unclear. There may be some areas of the brain that begin to malfunction for unknown reasons.

The hypothalamus is an area located at the base of the brain and responsible for the biological clock in the body, and can be a source of headaches.
Magnetic resonance imaging shows abnormal activity in the hypothalamus in patients during cluster headache attacks.

Characteristics of cluster headache:

  • There is a familial disposition in the development of this disease, which suggests that there may be a genetic component.
  • It can be triggered by a change in the sleep-wake rhythm.
  • It can be triggered by medication (for example, nitroglycerin in heart disease).
  • If a person frequently suffers from headaches, cigarette smoke, alcohol and some foods (for example, chocolate) can be possible causes of the headache.


Cluster headache can last for weeks or months, alternating with pain-free periods over months or years.
During the period of onset, the pain is pulsating and appears once or twice a day, but some patients may experience it more than twice a day.
Each episode of pain lasts between 30 to 90 minutes.
The attacks tend to occur at about the same time of day and often wake the patient from a deep sleep at night.
The pain is pervasive: usually it affects only one eye and its surroundings, but it can also radiate over the entire face, over the head and up to the cervical spine.
The affected eye may redden, swell and water.
The nose on the affected side may drip or block.
In contrast to migraine sufferers, individuals with cluster headaches tend to have an urge to move.
They often run back and forth, bang their heads against the wall and can be driven into a desperate situation.
Cluster headache is much more common in men than in women.


To establish a diagnosis, an accurate anamnesis of the patient is required. Usually, the description of pain and its frequency are sufficient.
If a patient is in the middle of an attack, he is in a critical situation due to the pain and, as described above, may have eye discomfort and a dripping nose.
If the patient is examined by a doctor if there is no pain, the physical examination result is normal and the diagnosis depends on the medical history.


Cluster headache can be very difficult to treat. You have to treat on a trial basis in order to find an effective therapy concept. Since the headache recurs daily, there are two requirements for therapy: the pain of the first episode must be controlled and the subsequent headache should be prevented.

The initial treatment options consist of:

  • Inhalation of high oxygen concentrations (although this does not work if the headache is well consolidated).
  • Injection of triptans, for example sumatriptan (Imigran), zolmitriptan (Zomig) and rizatriptan (Maxalt), which are also commonly used for migraine.
  • Infiltration with lidocaine, a local anesthetic, directly into the nostrils.
  • You can administer caffeine.

Prevention of the next cluster headache attack can be done by:

  • calcium channel blockers (for example, verapamil, diltiazem, nifedipine, nicardipine),
  • prednisone (decortin),
  • Antidepressants
  • lithium (lithium carbonate),
  • Fenobarbital, valproic acid and topiramate (often used to treat epilepsy).

Prevention of cluster headache

The episodes of cluster headache can be years apart and you can’t predict a new episode, no medication taken daily can guarantee that.
A change in lifestyle can help reduce the risk of cluster headache recurrence to a minimum.
Quitting smoking and minimizing alcohol consumption may lead to a reduction in future episodes.