A cluster headache is different from a migraine or a tension headache. It's also much less common. A cluster headache starts suddenly, without any warning. The pain can become severe within minutes. The headache is often brief. It can last only 15 minutes. Or it can continue for a few hours.
The pain is around one eye. You may have tears coming from that eye. That eyelid may become droopy. The eye may be red and swollen. You may also have a stuffy or runny nose on the affected side. People who have cluster headaches usually become restless and agitated and often pace during the headache.
You may also have several headaches in one 24-hour period. These may return at the same time of day during the cluster period. A cluster headache ends as suddenly as it began. It often leaves you feeling exhausted for some time afterward.
Cluster headaches often occur at night and during certain times of the year that are unique to you. A cluster period ranges from a few weeks to a few months. Then, the headaches may not come back for months or years.
Possible triggers include alcohol and smoking. Even a single alcoholic drink can trigger a headache during the cluster period. Other possible triggers include interrupted sleep patterns, physical activity, hot weather or hot baths, high altitudes, and bright light (including sunlight). Medicines like nitroglycerin can also cause a cluster headache. Cluster headaches affect those who are male more than those who are female.
Treatment for cluster headaches varies. Over-the-counter pain medicines usually don’t work fast enough to relieve these sudden attacks. High-flow oxygen and prescription triptan medicines given by injection or as a nasal spray can stop or shorten an attack. This is called acute or abortive treatment.
Preventive treatment can reduce the number of attacks during a cluster period. Verapamil, a blood pressure medicine, is commonly used. Steroids may provide short-term relief while another preventive medicine starts working. Anti-seizure medicines may also be used.
Certain nerve-stimulation devices may help stop or prevent attacks. If other treatments haven’t worked, a specialist may consider procedures that stimulate or block certain nerves. Invasive treatments, such as deep brain stimulation, are used only for severe chronic cluster headaches that haven’t improved with other treatments. These treatments have serious risks and may not always work. A neurologist or neurosurgeon provides these treatments.