Episodic Cluster Headache
This type accounts for roughly 80% of cluster headaches. Sufferers will have attacks with bouts of cluster periods which can last weeks or months, followed by pain-free periods called remission periods which can last months to years. They can often occur seasonally at set times during the year.
Chronic Cluster Headache
This type accounts for roughly 20% of cluster headaches. Sufferers will have attacks lasting for a year or more without remission periods. Some may have periods of headache-free days, however, remission periods often last less than one month.
How are Cluster Headaches diagnosed?
Cluster headaches are diagnosed primarily through a detailed history of the headache patterns and symptoms, and by ruling out other causes of the pain. It is critical to accurately diagnose cluster headaches as they can be very severe and manifest differently than migraines or tension headaches.
During a consultation, we will gather comprehensive information about the headache episodes, including their timing, location, frequency, and characteristics of the pain. To support the diagnosis, cluster headache patients may also undergo a physical and neurological examination as well as diagnostic tests, such as MRI or CT scans, to exclude other conditions. The distinctive nature of cluster headache pain and the absence of underlying causes often lead to a conclusive diagnosis.
Risk factors for Cluster Headaches
– Sex: Men are 5-6 times more likely to have cluster headaches than females
– Smoking can trigger cluster headaches. Heavy smokers, or persons whose parents are smokers have a greater risk of chronic cluster headaches.
– Alcohol: Significant alcohol consumption may be a risk factor.
– Age: The average age is between 20 to 50 years old, however, this condition can develop in all age brackets
– Family History: Having a family member with cluster headaches may also increase the risk
Managing Cluster Headache Triggers and Lifestyle Factors
While risk factors such as age, genetics, and sex cannot be changed, certain triggers can be managed to reduce the frequency and severity of cluster headaches. By making targeted lifestyle adjustments and incorporating preventive treatment strategies, many patients can minimise the impact of this condition.
Common Triggers for Cluster Headaches
- Environmental Factors
- Bright lights and glare (e.g., sunlight, screen exposure)
- Strong odours (e.g., petrol, perfume, tobacco, chemical fumes)
- Sudden temperature changes
Tip: Reducing exposure to known environmental triggers, such as wearing sunglasses outdoors or minimising exposure to strong smells, may help lessen attack frequency.
- Sleep Disruptions
- Irregular sleep patterns can exacerbate cluster headaches, as they are strongly linked to the body’s circadian rhythm.
Tip: Maintaining a consistent bedtime routine and avoiding late-night screen exposure may help stabilise your sleep cycle and reduce the likelihood of attacks.
- Food and Dietary Considerations
- While alcohol is a well-known trigger during active cluster periods, other dietary triggers may include:
- Nitrate-rich foods (e.g., processed meats)
- Aged cheeses
- Excess caffeine intake
Tip: Keeping a food diary can help identify patterns between dietary choices and headache flare-ups.
- Stress and Physical Tension
- Stress does not cause cluster headaches but can amplify their severity.
- Neck and shoulder tension may also contribute to increased discomfort during an attack.
Tip: Practicing relaxation techniques (such as deep breathing or meditation) and maintaining good posture can help manage muscular tension and stress-related triggers.
Cluster Headache Theory
As with many forms of headache, the cause of cluster headache was previously unknown. Medical professionals have been prescribing medications such as Triptans, which have been effective at relieving the pain, if taken early enough to ‘catch’ the headache. The effect of Triptans, as most doctors originally thought, was that it predominantly works on migraines as it helps prevent dilatation of the blood vessels in the head to stop migraines.
However, recent studies have shown that dilatation and expansion of the blood vessels are no different to those suffering from a migraine and those who are migraine-free. More importantly, the physiology of blood vessels in the head during a cluster headache do not expand, yet patients still benefit from medications such as Triptans.
There are other potential future treatments for cluster headaches currently being studied by researchers. These include sphenopalatine ganglion stimulation, occipital nerve stimulation and deep brain stimulation. These procedures have shown promise in treating the condition, however more studies need to be conducted.
Lifestyle Changes for Managing Cluster Headaches
While triggers vary between individuals, identifying and managing modifiable factors can support long-term relief. At Brisbane Headache and Migraine Clinic™, we focus on non-invasive, drug-free treatment to address underlying causes, helping patients manage their condition beyond just avoiding triggers.
What does a cluster headache feel like?
A cluster headache causes sudden, severe pain on one side of the head, most commonly around or behind one eye or the temple. The pain is often described as piercing, burning, or stabbing and can be intense enough to cause restlessness or agitation during an attack. Unlike migraine, people with cluster headache often feel unable to lie still.
How long does a cluster headache attack last?
A single cluster headache attack typically lasts between 15 minutes and 3 hours. Attacks may occur once or multiple times per day during an active cluster period, often following a predictable pattern.
What should I do during a cluster headache attack?
During an attack, many people find it helpful to move to a quiet, low-stimulation environment. Medical treatments such as high-flow oxygen or prescribed medications may be used to shorten or stop an attack. Because cluster headaches escalate quickly, having a clear management plan in place is important.
Are cluster headaches dangerous or life-threatening?
Cluster headaches are not life-threatening, but they are considered one of the most painful headache conditions. Due to the severity of symptoms, it’s important to rule out other causes of head pain and ensure an accurate diagnosis so appropriate management can begin.
Can cluster headaches go away, or do they last forever?
For many people, cluster headaches occur in cycles with periods of remission where symptoms completely resolve. Others may experience a more persistent pattern. With appropriate management and trigger awareness, many patients are able to reduce the frequency and impact of attacks over time.
How are cluster headaches different from migraines?
While both conditions involve severe head pain, cluster headaches differ from migraines in several key ways. Cluster headache pain is typically shorter in duration, strictly one-sided, and often accompanied by symptoms such as eye watering, nasal congestion, or eyelid drooping. Migraines more commonly involve nausea, light sensitivity, and a desire to lie still.
Why do cluster headaches often happen at the same time each day?
Cluster headaches are closely linked to the body’s internal clock, or circadian rhythm. This timing pattern is thought to involve activity in the hypothalamus, a part of the brain that regulates sleep, hormones, and biological rhythms, which helps explain why attacks often occur at similar times each day or night.
When should I seek professional help for cluster headaches?
You should seek professional assessment if you experience severe, recurring head pain, especially if attacks follow a predictable pattern or are associated with eye or nasal symptoms. Early assessment helps confirm the diagnosis, rule out other conditions, and establish an appropriate management plan.
