You get a cluster headache when a specific nerve pathway in the base of your brain is activated. That signal seems to come from a deeper part of the brain called the hypothalamus, where the “internal biological clock” that controls your sleep and wake cycles lives.
Cluster headaches generally reach their full force quickly — within 5 or 10 minutes.
The pain is almost always one-sided, and it stays on the same side during a period, the time when you’re getting daily attacks. (When a new headache period starts, it might switch to the opposite side, but that’s rare.) It’s often described as having a burning or piercing quality. It may be throbbing or constant.
You’ll feel it behind or around one eye. It may spread to your forehead, temple, nose, cheek, or upper gum on that side. Your scalp may be tender. You can often feel your blood pulsing.
Cluster headaches don’t make you queasy or throw up. But it’s possible for someone with cluster headaches to also get migraines, which can have those symptoms.
Although the pain starts suddenly, you may catch a few subtle cues of the oncoming headache on the affected side:
- Discomfort or a mild burning sensation
- Swollen or drooping eye
- Smaller pupil in the eye
- Eye redness or watering
- Runny or congested nose
- Red, warm face
You may begin to sweat a lot, or light may bother you.
Cluster headaches are more common in people who smoke or are heavy drinkers. During a cluster period, you’ll be more sensitive to alcohol and nicotine — just a bit of alcohol can trigger a headache. But drinking won’t trigger one during headache-free periods.
Possible Causes and Triggers
They may include:
- Cigarette smoke
- Weather changes
- Strong smells
- Bright or flashing lights
- Hot showers
The most successful ways to treat the pain are a shot of sumatriptan (Imitrex) and breathing oxygen through a face mask for 20 minutes. Other drugs used for migraines called triptans may work. Prescription medicines based on the ergot fungus and lidocaine nasal spray might also help.
You should take preventive medicine, unless your headache periods last less than 2 weeks. Your doctor can prescribe medication to shorten the length of the cluster as well as lessen the severity of your attacks, including:
- Divalproex sodium (Depakote)
- Ergotamine tartrate (Cafergot, Ergomar)
- Prednisone, for a short time
- Verapamil (Calan, Covera, Isoptin, Verelan)
When nothing else has worked, surgery may be an option for people who don’t get a break from cluster headaches. Most of the procedures involve blocking the trigeminal nerve.