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Cluster Headache - A Severe Pain Around The Eye

Updated on February 14, 2016

Hypothalamus of brain is believed to be the site of origin of cluster headache


Also known as Reader's syndrome, histamine cephalalgia and sphenopalatine neuralgia, cluster headache is an episodic type of pain in the head. It is characterized by one or three short lived attacks of pain around the eye that occur everyday for 4-8 weeks, followed by a pain free interval that averages around one year. The chronic form of this headache, which may begin de novo from the start or several years after an episodic pattern has become established, is characterized by the absence of sustained pain free phases. Episodic form may transform into chronic form, or the other way round that the chronic form may become episodic. It has a characteristic gender predilection in that men are affected seven to eight times more often than women. In most instances, it is not transmitted to future generations as a hereditary trait. Onset is usually between 20-50 years of age, but it may occur as early as in the first decade of life.

Cluster headache attacks are associated with tear and redness of the eye, nasal stuffiness, and drooping eyelid on the affected side


Characteristic Features Of Cluster Headache

Head pain typically develops around the eye or in the temple region on one side. It usually begins without warning and reaches a crescendo within 5 minutes. Sometimes warning attacks of sharp severe pain may precede the actual episode. It is often an excruciating pain, and is deep, non fluctuating and explosive in quality; only rarely is it pulsatile in nature. Pain is strictly unilateral, occurs only on one side, and usually affects the same side in subsequent months. Attacks last from 30 minutes to 2 hours. They are accompanied by associated symptoms of nasal stuffiness, watering and tears from the eye, reddening of the eye and drooping eyelid, all on the side of headache, along with nausea.

Alcohol provokes attacks in many individuals, but ceases to be provocative when the 4 to 8 week phase remits. This on-off vulnerability to alcohol is typical of cluster headache. In rare instances, food and emotional factors may trigger the attacks.

There is a striking periodicity of headache attacks in most sufferers. At least one of the daily attacks of pain recurs at about the same hour each day for the entire duration of the cluster bout (that is 4-8 weeks). Onset of headache is at night in around half of the people, in which case the pain causes awakening within 2 hours of falling asleep. in some individuals, attacks of severe headache and other symptoms recur at intervals without a long pain free gap phase. This variant is called chronic cluster headache.

Points to remember

  • Cluster headache is a severe pain around the eye on one side of the head that commonly occurs in middle aged men.
  • It is an excruciating, deep seated and non fluctuating type of pain.
  • Headache is associated with stuffed congested nose, tears and redness of the eye and drooping eyelid on the affected side.
  • It is an episodic pain that occurs everyday for 4-8 weeks, then there is a gap phase after which the pain could recur.

Causes Of Cluster Headache

A specific part of the brain known as hypothalamus is believed to be the site of activation of this disorder. Posterior part of hypothalamus contains cells that regulate the autonomic functions (heart rate, digestion, respiration or breathing and response of pupils of the eye), and the anterior or front part of hypothalamus contains cells that regulate the day night cycle (the circadian pacemaker). Activation of both these is necessary to trigger symptoms of cluster headache. Abnormalities in the "happy hormone" serotonin neuro transmission at these sites precipitates the pain.

Trigger factors of cluster headache during a bout :

  • Alcohol and cigarette smoking
  • High altitudes (trekking, air travel)
  • Bright light (including sunlight)
  • Exertion
  • Heat and hot baths
  • Foods high in nitrites.

Typical of cluster headache

What are the characteristic features of cluster headache?

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Oxygen Inhalation is a safe and non-invasive therapy for Cluster Headache


Oxygen inhalation via a non rebreather mask abates an attack of cluster headache

Non rebreather mask
Non rebreather mask | Source

Medication during an attack

The therapies that can reduce the intensity and gradually resolve a severe episode of cluster headache include the following :

  • Oxygen inhalation via a non rebreather mask (at least 15 minutes of inhalation of 100% oxygen is necessary for five times every day during the cluster headache episode). In this therapy oxygen cylinders are given for home use. Non rebreather mask covers your mouth and nose, and has a bag below to conserve the pure oxygen (not tubes that are put in your nostrils). The mask is connected to a humidifier and then to the Oxygen cylinder. This therapy has a slow onset of action. It works better for episodic type of cluster headache as compared to the chronic type. It can even be used as an additive along with sumatriptan injections for faster and more complete pain relief.
  • Lidocaine (self administered)
  • Sumatriptan (subcutaneous) : This will shorten the duration of an attack to 10-15 minutes.

Pain in cluster headache is deep, non fluctuating and explosive in quality


Transcutaneous Electrical Nerve Stimulation


Preventive therapy

Maintain a headache diary to identify and avoid trigger factors. The medicines that can be used to prevent episodes of pain until the 4-8 week bout is over, include the following :

  • Verapamil
  • Prednisolone
  • Lithium

Certain therapies can also prevent cluster headache episodes. These include :

  • Deep brain stimulation : This is a surgical procedure in which a pulse generator or a brain pacemaker, that is a battery operated device, is implanted under the skin below the collar bone (clavicle) or on the abdomen. This is connected through an extension wire which runs below the skin, to a lead (a coiled wire with four Platinum-Iridium electrodes) that is placed at a specific site in the brain. Electrical pulses are generated by the brain pacemaker and transmitted through the extension to the electrodes to interfere nerve activity at the required area, and thus reduce pain intensity.
  • Transcutaneous electrical nerve stimulation : This therapy is under research as a preventive procedure for chronic pain. It uses low voltage electric current for pain relief. For this, a small battery operated device is used, which is connected through wires to a set of electrodes that are placed near the site of pain. When the current is delivered, it stimulates nerves in the affected area and sends signals to the brain that block the normal pain transmission. Electrical stimulation of the nerves also helps the body to produce natural painkillers called endorphins.

Characteristics of Cluster Headache

Medication during an attack
Preventive therapy
Pain on one side of head
Oxygen inhalation
Red, tearful painful eye
Stuffed nose

Reference sources

  1. Cluster Headache - WebMD . headaches
  2. Cluster headache : MedlinePlus Medical Encyclopedia.


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