What Are Cluster Headaches?

Cluster headaches tend to be very painful and occur in patterns of what can be described as “clusters.” These headache clusters are episodes of headaches that occur with great frequency, followed by latency periods with no headaches.

These headache clusters may be unpredictable and can last for weeks or even months, with headache-free periods of varying lengths in between. Cluster headaches are often described as intense pain on one side occurring behind the eye. They can be debilitating, though symptoms vary widely.

The periodic nature of cluster headaches is a bit of a mystery, but it is clear that the occurrence of these headaches can be exhausting. Patients suffering from cluster headaches cannot predict when these clusters will come, and prolonged periods of headache pain can cause significant impacts on patients’ lives.


Are there specific risk factors for cluster headaches?

Cluster headaches seem to occur more often in men and more often in smokers.

There is some thought that the dilation of blood vessels may be related to cluster headache pain since certain vasodilator drugs such as nitroglycerine and histamine can cause attacks in some patients. This blood vessel dilation may cause pressure on the peripheral nerves of the head and neck to trigger headache episodes.

There also seems to be some genetic predisposition to these headaches, as patterns within families have been observed.

Can headache surgery really help cluster headaches?

In many patients, the irritation of the peripheral nerves that are addressed during headache surgery can be a major trigger of headache pain. During the workup for headache surgery, these nerve triggers are identified through a series of specific nerve blocks which can indicate if a patient is a good candidate for headache surgery.

What are the signs and symptoms of cluster headaches?

Cluster headaches get their name from the fact that they occur in groups, or “clusters.” During a cluster cycle, brief, excruciatingly severe headache attacks recur between one and eight times per day. Pain severity is identified as 10 out of 10.

These headaches occur on one side of the head, and symptoms occur on the same side of the head as the pain. These can include red or teary eyes, runny or stuffy nostrils and flushing or sweating of the face. During attacks, some people develop a smaller pupil or a drooping eyelid on the affected side.

Most cluster headache patients are agitated. This differs from migraine patients who try to stay as still as possible. The pain of a cluster headache comes as searing, stabbing pain that usually occurs behind one eye or at the temple near the forehead.

Cluster headaches are shorter than migraines, lasting between 15 minutes and three hours. They come in cycles that often occur once or twice over the course of a year. Timing can be unpredictable as cluster headaches can go away for years before returning.

When should I consider surgery to address my cluster headaches?

Surgery is usually considered as the last option. It is only recommended for patients who don’t find relief with other treatments or who can’t tolerate the medications or their side effects.

If an occipital nerve block has been helpful in the past, you can be very confident that surgery is a good option for you. If occipital nerve blocks have not worked, Dr. Lowenstein can administer one himself to ensure it was done correctly. Many patients who have not had success with other nerve blocks respond well when Dr. Lowenstein performs the block.

What causes cluster headaches?

While the cause of cluster headaches is not completely understood, their periodic nature indicates that they might be related to triggers in the hypothalamus, which is the control center of the brain. The hypothalamus controls circadian rhythms that help with sleep patterns. Special studies that look at metabolic activity in the brain have identified the hypothalamus as an area of enhanced activity during cluster headaches.

How are peripheral nerves related to cluster headaches?

Alterations in the hypothalamus seem to have a relationship to changes in the trigeminal regions of the brain, which control activity from the peripheral sensory nerves of the head and neck. These peripheral nerves, which are addressed during headache surgery, appear to have a role in triggering cluster headaches.

How common are cluster headaches?

Little research has been done on cluster headaches, but it is estimated that between 200,000 and 1 million people are living with cluster headaches in the U.S.

Onset for those unfortunate enough to have them usually comes between the ages of 20 and 40. Men are somewhat more likely to have cluster headaches, and there appears to be a genetic component, although it does not always pass down through subsequent generations.

Can you prevent a cluster headache from starting?

Many doctors mistakenly lump cluster headaches in with migraine headaches, but these are two very different conditions. Dr. Lowenstein understands the difference and can help patients with cluster headaches find relief.

Cluster headaches can sometimes be prevented with drug treatment. Corticosteroids injected into the back of the head are often the first preventive treatment. From there, various drugs can shorten attacks and make them less severe. Some of these drugs are divalproex sodium, ergotamine tartrate, gabapentin, lithium carbonate, topiramate and verapamil.

The occipital nerve is located at the base of the skull and seems to be the starting point for cluster headaches. An occipital nerve block can also be an effective temporary prevention measure. If an occipital nerve block does provide even temporary pain relief, then nerve decompression surgery by Dr. Lowenstein is likely to provide long term pain relief.

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