Headaches: Cluster - Cluster Headaches

Highlights	Risk Factors	Surgery
Introduction	Diagnosis	Resources
Cluster Headaches	Managing Cluster Headaches	References
Causes	Treatment
Prognosis	Medications

Cluster Headaches

Cluster headaches are among the most painful of all headaches. The signature is a pattern of periodic cycles of headache attacks, which may be one of the following:

Episodic (occurring regularly for weeks to months, followed by long pain-free periods), or
Chronic (occurring without sustained breaks).

It should be noted that a significant percentage of people who experience a first cluster attack do not have another one.

Episodic Cluster Headaches. Between 80% and 90% of cluster headache patients have episodic cluster headache cycles.

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Chronic Cluster Headaches. About 10% to 20% of cluster headache patients have a chronic form that lasts more than a year, with remissions lasting less than one month. Two chronic subtypes have been defined:

Chronic cluster headache that is unremitting from the onset. This type may be more commonly associated with heavy alcohol use.
Chronic cluster headache that has evolved from episodic cluster. One study found a higher risk for this form in patients who developed cluster headaches in their thirties or older and who had more frequent attacks and shorter remissions than average. Another study suggested that this condition occurs more often in heavy smokers, although the link is uncertain.

Symptoms of Cluster Headaches

Cluster symptoms tend to occur during spring, autumn or both and they most often occur at night. The course of symptoms varies and may include the following:

Prodromal Symptoms. Over half of cluster headache patients experience warning symptoms, long before an attack. They are called prodromal, or premonitory, symptoms. Such symptoms occur from one day to up to two months before an actual cluster headache attack. (On average, they develop about week before an attack.) They include the following:

Strange tingling sensations around the eye, nose, or neck (occurs in about third of patient who have prodromal symptoms).
Nasal congestion or runny nose, excessive tearing (in about two thirds of patients).
Feeling restless or depressed (about two thirds of patients).
Other premonitory symptoms reported include fatigue, neck ache, stiffness, odd sensations in the limbs, or an extreme sensitivity in the area where the headache will develop.

Symptoms Signaling the Onset of an Attack. Over three-quarters of patients report tingling sensations and irritability minutes to hours preceding an attack. A minority of patients experience migraine-like auras (which are odd sensory experiences, such as seeing shimmering light or blind spots).