cluster headache treatments - colorado pain care blog

Headaches are a part of life for most people, but in most circumstances they are relatively minor annoyances that are remedied with an aspirin. For some people, however, headaches are torturous experiences that greatly interfere with their lives. For these people, in order to maintain a normal life is imperative to find treatment for their cluster headaches.

It is believed that up to 80 or 90 percent of adults experience headaches at some point in their lives, but most people only suffer from tension headaches which produce mild to moderate pain for relatively short periods of time. However, about 15 percent of adults suffer from headaches with severe pain like migraines or cluster headaches.

How to Identify Cluster Headaches

About one in a thousand people suffer from the excruciating pain of cluster headaches. The symptoms of cluster headaches include:

  • Intense pain—many people who experience cluster headaches argue that they produce most pain of any health condition. Some patients describe it as “a white-hot poker into your eye socket.”
  • Pain features—usually this condition produces pain on only one side of the head. It may center on one eye, a temple or the forehead, but may spread to other areas including other areas of the head, neck and shoulders.
  • Episodes—cluster headaches often start about an hour or two after falling asleep.  Each episode may last from 15 minutes up to three hours, with pain increasing in intensity for up to 30 or 60 minutes.
  • Seasonal—no one understands why but in almost 80 percent of sufferers, cluster headaches appear for 4 to 12 weeks in the spring or autumn. For many patients, these headaches may then disappear for many months or, even, years.  For one in five sufferers, however, this condition appears year-round.
  • Accompanying symptoms—many people also suffer from runny nose, drooping eyelid or redness in one eye.
  • Initial appearance—this health condition may appear at any age, but often starts in young adulthood.  Many patients experience a decline in episodes as they age.   Unlike migraines, cluster headaches appear more often in men than women.

It is often difficult to diagnose cluster headaches as they present with similar symptoms to migraines or severe headaches. There is no diagnostic test to distinguish cluster headaches from other health conditions. It may take an experienced pain management specialist to make a correct diagnosis and begin an effective headache treatment program.

Cluster Headache Causes

What causes cluster headaches is not well understood, but research suggests that the hypothalamus region of the brain plays a key role. The hypothalamus is responsible for maintaining the circadian rhythm or the day/night biological cycle. When cluster headaches strike, the hypothalamus flares up with activity and triggers the trigeminal-autonomic reflex pathway in the brainstem, the neural pathway for facial sensation. It remains a mystery why many patients experience cluster headaches at only certain times of the year.

Although there are no known triggers that initiate a round of cluster headaches (other than seasonal changes), there are some stimuli that may trigger a headache within these seasonal periods. Many people have reported that cluster headaches appear after drinking alcohol or smoking. Studies also show that some people experience cluster headaches after strong smells like gasoline, perfume or bleach.

Headache Treatment

Presently, there is no cure for cluster headaches, but there are an increasing number of effective headache treatments. One of the most powerful ways to treat cluster headaches is to recognize the onset of a cluster headache and take immediate steps to inhibit intensification.  Normal painkillers are not effective in relieving such potent pain and often take too long to work, but there are other proven therapies.

One acute pain management technique is to breathe pure oxygen. Studies show that patients that inhale 7 to 12 liters of oxygen a minute can stop or weaken a cluster headache episode. The oxygen should begin to work within 15 to 20 minutes. This treatment may be quite pricey because major insurers like Medicare and Medicaid do not cover oxygen therapies for cluster headaches.

The medicinal compound sumatriptan, marketed under the name Imitrex, is one of the most effective acute therapies for migraines and cluster headaches. Sumatriptan is available as a pill, nasal spray or injection, but only the latter two forms should be used in acute situations, since the pill takes too long to act. If you have any cardiovascular issues, discuss them with your pain doctor prior to starting a sumatriptan therapy.

Long-term Therapies

There are a growing number of long-term headache medications that may prevent cluster headaches. These include:

  • Verapamil—this drug should be taken daily to prevent episodic and chronic cluster headaches.  However, you will need to be closely monitored by a pain management specialist to ensure that no heart issues develop.
  • Lithium—in low doses, lithium can be a potent therapy for cluster headaches.
  • Ergotamine—is a rarely prescribed drug because it has been linked to ischemia (a blockage in an artery) but can limit the number of nighttime cluster headaches.
  • Methysergide—is a possible headache treatment for episodic cluster headaches that your doctor may recommend if other therapies have proven ineffective.  Although methysergide may relieve cluster headaches, it has a side effect of producing fibrosis or scar tissue on organs. Due to its toxicity, you should only use this drug for periods less than six months.
  • Corticosteroids—some patients respond well to 2 to 3 week corticosteroid treatments that help shorten seasonal cluster headache periods.   If discontinued, the cluster headaches may return.

Not all of these headache treatments are likely to prove successful for you, so you should work with your pain management physician to identify what therapies are most effective for you personally.

Living with Cluster Headaches

In the past, living with cluster headaches was an arduous ordeal, but modern medicine has made major inroads into the treatment of this mysterious illness.  With proven therapies like oxygen, sumatriptan and corticosteroids, more people are finding a way to ward off the worst effects of cluster headaches.


Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.