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Cluster Headaches

Cluster headaches are recurring attacks of excruciating pain on one side of the head, often behind an eye. The pain may extend to the forehead, nose, cheek, upper jaw or back of the head on the same side. The attacks often happen multiple times per day with each attack lasting less than three hours, even without treatment. Most often, the attacks occur every day for several weeks or months and then subside for a period, though for some people the attacks can continue for months or even years.

Men experience cluster headache three to four times more often than women. Generally, this condition does not run in families.

Cluster headache attacks may occur nearly every day or several times a day for weeks or months and then disappear for months or even years. Attacks may last from 15 minutes to three hours, and often occur during the night.

There are two kinds of cluster headache: episodic and chronic. Those suffering from episodic cluster headaches have relatively long, pain-free remissions between headaches. Chronic cluster headache sufferers do not have long remissions. If during the past year or longer, you have had only one month or less of relief between headache attacks, you may have chronic cluster headache. About 10 percent of people with cluster headaches are considered chronic sufferers.

Other symptoms, which typically occur on the same side as the pain, include:

  • Red or teary eyes
  • Runny or stuffy nose
  • Facial swelling

Cluster headaches are characterized by a specific type of pain and pattern of attacks. Keeping a headache journal is a great way to track the location, severity and duration of pain; medications; and possible headache triggers.

A physical exam may help your doctor detect signs of a cluster headache. One of your pupils may appear smaller than the other or your eyelid may droop.

If your doctor suspects a tumor or aneurysm, he or she may order one or more of the following tests:

  • Computerized Tomography (CT) Scan — A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to construct a 3-D, cross-sectional image.
  • Magnetic Resonance Imaging (MRI) — An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain. Under the right circumstances, MRI and other imaging procedures allows doctors to actually see how the larger structures in the brain are involved during migraine and headache.

Taking medications to prevent cluster headaches before they occur is typically the most effective treatment for cluster headaches. These medications include:

  • Calcium Channel Blockers — Calcium channel blockers, such as Verapamil, which relax the muscles in the walls of your blood vessels, may help prevent cluster headaches.
  • Anti-seizure Medications — Medications used to control seizures in conditions such as epilepsy may be prescribed to help control cluster headaches. These include divalproex topiramate and gabapentin.
  • Lithium — This medication may help prevent chronic and episodic cluster headaches.
  • Corticosteroids — These anti-inflammatory drugs, such as prednisone, may provide relief from headache pain.

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Reviewed by health care specialists at UCSF Medical Center.

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Neurology and Neurosurgery

Headache Center
1701 Divisadero St., Suite 480
San Francisco, CA 94115
Phone: (415) 353-8393
Fax: (415) 353-9539
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