Cluster headache: The most painful condition known to humankind?

Written by: Dr Mark Weatherall
Published: | Updated: 20/09/2023
Edited by: Nicholas Howley

What is a cluster headache exactly, and how does it differ from a normal headache? We asked Dr Mark Weatherall, consultant neurologist with a subspecialist interest in the management of headaches.

What is a cluster headache like?

Cluster headache is one of the most painful medical conditions known to humankind. It is characterised by very severe, one-sided headaches, usually around or above the eye. These last 15-180 minutes and can occur up to eight times a day.

Attacks often come at the same time of the day or night, leading to the name ‘alarm clock headache’. Other symptoms can often include:

  • redness of the eye
  • tears
  • nasal congestion
  • forehead or facial sweating
  • drooping or swelling of the eyelid

 

Living with cluster headache

Most sufferers have episodic cluster headache, in which attacks come in bouts, usually lasting a few weeks, and often in the spring or autumn. A small proportion have chronic cluster headache, in which attacks continue for months or years at a time with no remission.

Cluster headaches have a huge impact on sufferers’ work and social lives . One-quarter of patients experience absenteeism or job loss, and nearly one in ten are unemployed or on disability payments because of their disorder.

The excruciating intensity of the attacks has led some people to dub it the ‘suicide headache’.

 

Why cluster headaches happen

Cluster headache is slightly more common in men than women, and often starts in the 20s or 30s, though it can occur later in life.

In rare cases, cluster headache runs through families, indicating a genetic component, but no specific genetic abnormality has yet been discovered. Functional brain scans show that central brain mechanisms (particularly in the hypothalamus) play pivotal roles in the condition.

Unlike migraine, cluster headaches are rarely triggered by external factors, though some patients find that when they are in a bout, alcohol will set off an attack almost instantly.

 

The good news is that cluster headaches can be treated

The main focus of therapy is to abort attacks once they have begun and to prevent future attacks. Cluster headache attacks need fast-acting abortive agents because the pain peaks very quickly. The painkiller sumatriptan (given as a nasal spray or a subcutaneous injection) and high flow 100% oxygen are the only effective acute treatments.

First line preventative drugs include verapamil and lithium. A course of steroids can be effective in settling down a cluster bout, as can an occipital nerve block with local anaesthetic and steroid.

If these treatments don’t work we can offer various forms of neurostimulation, including:

  • occipital nerve stimulation
  • vagus nerve stimulation
  • sphenopalatine ganglion stimulation
  • hypothalamic stimulation

Finally, a number of trials are ongoing to explore new types of treatment for cluster headache. For example, monoclonal antibodies could be engineered to fight against calcitonin gene-related peptide (CGRP). This could in turn desensitise the neurons in the head and prevent the onset of cluster headache attacks.

In the future, we can look forward to significant improvements in how we manage cluster headache, and restore quality of life to the many people affected.

By Dr Mark Weatherall
Neurology

Dr Mark Weatherall is one of just a few consultant neurologists in the UK with a subspecialist interest in the management of headaches, and is an expert in headaches of all kinds, from tension-type headaches and migraines to cluster headaches. He also specialises in the treatment of stroke, Parkinson's disease and visual snow and is based in London and Buckinghamshire.

Dr Weatherall qualified in clinical medicine in 1997 from the University of Cambridge before going on to complete further specialist training in neurology. Prior to this, Dr Weatherall was a renowned historian of medicine with a PhD in the subject. He was appointed consultant at Buckinghamshire's Stoke Mandeville Hospital in 2018 having previously run the Princess Margaret Migraine Clinic at Imperial College Healthcare NHS Trust for ten years. He currently sees patients in private practice at the Medical Chambers Kensington and BMI The Chiltern Hospital.

Dr Weatherall's work is widely published in international medical magazines and peer reviewed journals. He is a member of numerous professional organisations within his field, including the British Association for the Study of Headache and the International Headache Society.

Many of Dr Weatherall's patients have suffered from chronic headaches for some time and have previously been unable to find an effective treatment solution or diagnosis. He is passionate about finding the best approach to treatment for each of his individual patients by making use of the latest advances in research along with his extensive clinical knowledge

View Profile

Overall assessment of their patients


  • Related procedures
  • Botulinum toxin (Botox™)
    Neuropsychology
    Sleep disorders
    Learning disabilities
    Tinnitus
    Obstructive sleep apnea
    Neurological treatments
    Chronic headache
    Neuropathic pain
    Epilepsy
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.