​Cluster Headache

Cluster headaches are a neurological disorder (that is, a disorder related to the brain) that causes repeated, severe headaches, usually around one side of the head and the eye. You may experience an episode between once to thrice daily during the cluster period, that is, a period of time during which these headaches are active. This period may last from two weeks up to three months. You are likely to suffer from cluster headaches at the same time each year, such as the spring or fall.

A cluster headache is strong enough to awaken you from sleep. Nocturnal attacks (attacks which happen at night) can be more severe than daytime attacks. Cluster headaches can even be more intense than migraines but they do not last as long. During the remission period, the headaches may disappear completely for months or years, but recur without any warning.

The exact cause of cluster headaches is unknown but they occur when a nerve pathway in the brain (known as the trigeminal-autonomic reflex pathway) is activated. This is the main nerve of the face responsible for sensations.

Unlike migraine and tension headache, cluster headache generally isn't associated with triggers such as stress. These are the rarest form of headaches, but men are more likely to develop it than women.

A cluster headache starts without any warning. Common signs and symptoms include:

  • Unbearable pain, usually around one eye. It may also extend to other areas of your face, head, neck and shoulders

  • Pain restricted to one side of the head

  • Restlessness

  • Redness in your eye on the affected side

  • Stuffy or runny nasal passage

  • Sweaty skin

  • Swelling around your eye

  • Drooping eyelid

Some symptoms between cluster headaches and migraine are common, including nausea and sensitivity to light and sound, but with a cluster headache you choose to pace around restlessly rather than lie down like you would do in a migraine. The pain of a cluster headache often feels like a sharp penetrating or burning feeling.​

If you or a loved one is experiencing regular, sudden, intense headaches or any of the symptoms mentioned above, it is recommended that you consult with your doctor immediately. You can obtain additional information from the doctors at the Mind and Brain Service Line​ at The Aga Khan University Hospital.
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.

Cluster headache has a characteristic type of pain and attack pattern, so your diagnosis will depend on your description of the attacks. The details you will be asked for will include:

  • Duration of the attack

  • Nature of the pain

  • Location, frequency and severity of your headaches

  • Other associated symptoms

A neurological examination may also be conducted to help your doctor detect physical signs of a cluster headache. This includes imaging tests such as:

  • Magnetic Resonance Imaging (MRI) scan: This is a type of brain scan which uses strong magnetic fields and radio waves to produce detailed images of the inside of your body. It can be used to detect possible causes of the condition. An MRI scanner is a large tube that contains powerful magnets. You will have to lie inside the tube during the scan and it will produce a picture of your brain.

  • Computerized Tomography (CT) scan: This is an imaging method that creates a two-dimensional image of the brain using X-ray technology.​

There's no perfect cure for cluster headaches. Your treatment will be aimed at decreasing the severity of pain, shorten the headache period and prevent future attacks.

Some types of acute medication can provide pain relief quickly. These include:

  • Inhaling pure oxygen using an oxygen mask

  • Triptans (migraine medication)

  • Local anaesthetics

  • Calcium channel blockers (these have side effects such as constipation, nausea, fatigue, swelling of the ankles and low blood pressure).

  • Inflammation-suppressing drugs

  • Lithium carbonate (side effects include tremors, increased thirst and diarrhoea)

  • Anti-seizure medications

In rare cases, your doctor may recommend surgery if there is no other way to get relief or the medication has too many side effects. Surgical procedures can be used to damage those nerve pathways where the pain is originating from. However, there are many risks and possible complications so this option is not commonly suggested.​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.
The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.
The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.
Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.