Is cluster headache considered migraine? Treated with surgery?

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  • Full Question:

    I suffer with Cluster Headaches (severe pain behind my eye, as if someone were using an ice pick behind my eye ball.)  This is the only symptom. I take Imitrex which can stop the onset if taken early enough. Sometimes it comes on without much warning and the although the medicine might lessens the pain, it is still severe and debilitating.

    I have tried taking daily medicine to prevent it, but it didn't stop or lessen the headaches.

    Is a Cluster Headache considered a migraine? If there is a nerve that causes the headache, is there a way to know which nerve, and could it be treated surgically?

    I have headaches at least a couple times a week.  Some good news would be most welcome! Susan.


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    Full Answer:

    Dear Susan;

    Thanks for your question regarding cluster headache and treatment options. No, cluster headaches are not migraines. They're a totally different headache disorder. Cluster headache is one of the most severe forms of headache or other type of pain anyone can have and has been called the "suicide headache" due to the severity of the pain and the agitation that often goes with it.


    Interestingly, cluster headache is much more common in men than in women, although it certainly can still occur in women. It is a one-sided headache, usually in or around the eye and the temple area, lasting anywhere from about 30 minutes to 3 hours if left untreated. Often it will wake people from sleep, even just from a daytime nap, but can occur during the day as well. When the headache occurs, usually the eye on the side of the pain will turn red or water, or even the eyelid can droop. They occur from every other day up to 8 times per day, and are called "cluster" because typically they will occur for a few weeks to a couple months, then stop for a prolonged period of time. Many people with cluster headaches have 1-2 cluster cycles per year. You can read more about cluster headaches in Cluster Headaches - The Basics.


    It's great that sumatriptan gives you relief usually. Sumatriptan comes in pill form but also in nasal spray and injectable form. The injectable form works best for cluster headaches, but if you have a lot of headaches can lead to a lot of injections. Preventive options for cluster headache include oral medications such as verapamil (a blood pressure medication), anti-seizure medications such as topiramate and valproate, high doses of melatonin, and even lithium if the cycles become chronic. Other treatments could include high doses of oral steroids (prednisone), greater occipital nerve blocks, or repeated infusions of intravenous DHE-45. In reality, there are too many possible treatments to do them all justice here, but it is important for you to talk with your doctor about what options are available. If you haven't already, you may consider seeing a migraine and headache specialist. If you need help locating one, see our Migraine and Headache Specialist Listings.


    At this point there are not any well studied, proven surgical treatments for cluster headache. Maybe one day there will be, but not yet. Be very cautious about advertised treatments that call themselves a "cure" or that report overwhelmingly positive outcomes. Surgery is permanent.


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    Lastly, if pain is truly the only symptom you have, meaning that you don't develop a red or watery eye, a runny nose, or an eyelid droop on the side of your headache when they occur, you may want to talk with your doctor about the possibility that you haven't responded to cluster treatments because you may not actually have cluster headache.

    Thank you for your question,
    David Watson, MD, and Teri Robert


    About Ask the Clinician:

    Dr. David Watson is a UCNS certified migraine and headache specialists and director of the Headache Center at West Virginia University. Je and Lead Health Guide Teri Robert, team up to answer your questions about headaches and  Migraines. You can read more about Dr. Watson or more about Teri Robert.


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    Last updated August 23, 2014.




Published On: August 28, 2014