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Cluster Headache

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Last updated January 12, 2022

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What is a cluster headache?

Cluster headaches are among the most severe of all headaches. They cause intense penetrating pain in and around one eye.

Most people with cluster headaches have them episodically—a cluster of one to three headaches a day over a period of weeks or months, alternating with headache-free periods.

About 20% of people have the chronic form, in which daily bouts continue for a year or longer. Chronic headaches are less easily treated by drug therapy than episodic cluster headaches.

Cluster headaches are more common in men, with the first attack usually striking during adolescence or the early 20s. For people who get cluster head­aches, smoking cigarettes and drinking alcohol can trigger attacks during cluster periods but not during remissions.

Al­though they are excruciatingly painful, there is no permanent harm or link to other diseases.

There is no known cause or cure for cluster headaches, which can be a lifelong disorder.

Symptoms

The typical cluster headache starts suddenly, usually 2 to 3 hours after you fall asleep. The pain is an intense, steady, burning, penetrating sensation, usually behind one eye but occasionally in the cheek, near the ear, or nearby. The affected eye may be watery and bloodshot, the eyelid droopy, the nostril initially stuffy and then runny, and the cheek flushed and swollen.

During a single bout, all symptoms occur on either the left or the right side, never both at once. Most people find that the same side is always affected.

After an hour or two, the pain and other symptoms usually lessen, sometimes as suddenly as they started, only to recur at the same time day after day.

Treatment

See a doctor to get the correct diagnosis and medications that can help prevent or treat an attack. Over-the-counter pain medicines such as aspirin, ibuprofen, and acetaminophen are not usually effective against cluster headaches, mainly because they take effect too slowly.

One of the most effective treatments is inhaling oxygen supplied by a tank through a mask for 15 minutes. Medications that can help include triptans, ergotamine, cortico­steroids, and calcium channel blockers.

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