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Cluster Headaches - The Basics

by Teri Robert, Lead Expert

Cluster headaches are often said to be the most painful of all headaches. They have been described as "boring," bearing, burning," "like a hot poker in the eye," and as "suicide headaches." The age of onset of cluster headaches is most often between the ages of 20 and 40, and they are more common in men than women at a ratio of 2.1. For many years, that ratio was stated to be 3:1. Researchers theorize that women have long been misdiagnosed because cluster headaches were thought to be so predominantly found in men.

Several terms have previously been used to refer to cluster headaches: ciliary neuralgia, erythro-melalgia of the head, erythroprosopalgia of Bing, hemicrania angioparalytica, hemicrania neuralgiformis chronica, histaminic cephalalgia, Horton’s headache, Harris-Horton’s disease, migrainous neuralgia (of Harris), petrosal neuralgia (of Gardner).

Cluster headache symptoms:

Cluster headaches are attacks of severe pain lasting 15-180 minutes and occurring from once every other day up to eight times in one day.

The pain is:

  • severe

  • unilateral

  • orbital (near the orbit, the bone framing the eye), supraorbital (above the orbit), temporal (at the tempe), or a combination of those sites.

These attacks also include one or more of these symptoms ipsilaterally (on the same side as the pain):

  • conjunctival injection (forcing of fluid into the conjuctiva, the mucous membrane that lines the eyelids)

  • eyelid edema (swelling)

  • forehead and facial sweating

  • lacrimation (tearing)

  • miosis (abnormal contraction of the pupils)

  • nasal congestion

  • rhinorrhea (runny nose)

  • ptosis (drooping eyelid)

Most cluster headache patients are restless or agitated during attacks and find it hard to be still. Cluster sufferers characteristically pace the floor during an attack.

Cluster headaches are diagnosed as "episodic" when the attacks occur in periods lasting 7 days to 1 year separated by pain-free periods lasting 1 month or longer. In "chronic" cluster headaches, attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.

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