# cluster headache | Symptoms, Causes, Tests and Treatment | OSANG > Cluster headaches are headaches that occur repeatedly at the same time, 1 to 8 times a day, for weeks to months, during a cluster period. The pain intensity is one of th… - Official page: https://osns.co.kr/en/encyclopedia/cluster-headache - Organization: OSANG Neurosurgery ## Page content Headache ## cluster headache Cluster Headache · G44.0 Cluster headache is a trigeminal autonomic headache in which severe pain around one eye or in the temporal area lasts for 15 minutes to 3 hours, occurs repeatedly at the same time, and is accompanied by autonomic symptoms such as tearing, runny nose, and drooping eyelids. ## At a glance Cluster headaches are headaches that occur repeatedly at the same time, 1 to 8 times a day, for weeks to months, during a cluster period. The pain intensity is one of the most severe among known headaches and is approximately three times more common in men than in women. Activation of the trigeminal-autonomic reflex pathway is the key mechanism, and oxygen inhalation and sumatriptan injection are the primary treatments in the acute phase. - 01Definition and Overview - 02Classification - 03Causes and Mechanisms - 04symptoms - 05diagnosis - 06treatment ## Definition and Overview Cluster headaches are the most common and severe form of trigeminal autonomic cephalalgias (TACs). Severe pain around one eye, behind the eye socket, temporal area, or forehead lasts for 15 minutes to 3 hours, and is accompanied by one or more autonomic symptoms on the ipsilateral side, such as lacrimation, conjunctival injection, nasal congestion or runny nose, ptosis, miosis, eyelid edema, and forehead sweat. Because the pain intensity is so extreme, it is also called a “suicide headache.” The prevalence rate is about 1 per 1,000 people, which is not uncommon, and is about 3 times more common in men than in women. ## Classification Cluster headaches are classified according to the pattern of cluster periods and remission periods as follows. - Episodic cluster headache: Cluster periods lasting 7 days to 1 year followed by remission periods of 3 months or more. It accounts for approximately 85-90% of all patients. - Chronic cluster headache: Attacks last for more than a year without relief for more than three months. It is about 10-15% of the total. ## Causes and Mechanisms ### Trigeminal nerve-autonomic reflexes The core mechanism of cluster headache is trigeminal nerve activation and the resulting parasympathetic nerve reflex. When the trigeminal nerve is activated, neuropeptides such as CGRP (calcitonin gene-related peptide) and vasoactive intestinal peptide (VIP) are released from meningeal blood vessels, causing vasodilation and inflammation. ### Hypothalamic involvement Functional MRI studies show activation of the posterior hypothalamic gray matter during attacks. This explains the temporal periodicity (circadian pattern, seasonality) of headaches and is a target for deep brain stimulation (DBS). ## symptoms ### headache attack - Attack duration: 15 minutes to 3 hours (average 45 to 90 minutes) - Attack frequency: 1 to 8 times per day, repeated during cluster periods. - Pain pattern: extreme stabbing pain, burning pain - When it occurs: Commonly occurs 1 to 2 hours after nighttime sleep; Seasonally, cluster periods often begin in spring and fall. - Agitation during an attack: Unlike a migraine, the person cannot remain still during the attack and paces or shakes the body. ### Autonomic symptoms (ipsilateral) Excessive lacrimation, conjunctival injection, nasal congestion or runny nose, ptosis, miosis, and forehead or facial sweating may occur ipsilaterally during the attack. ## diagnosis The diagnosis of cluster headache is a clinical diagnosis according to the International Headache Society (IHS) classification criteria (ICHD-3). Assess headache location, duration, accompanying autonomic symptoms, and cluster pattern. It is recommended to perform brain MRI and cerebrovascular MRA examination early in the diagnosis to rule out secondary causes (brain aneurysm, brain tumor). ## treatment ### acute care Because the duration of cluster headache attacks is short, oral medications have limited effectiveness, and the following treatments are prioritized. - High-flow oxygen inhalation: Most often mask inhalation of 7 to 12 liters of oxygen per minute for 15 minutes. Studies have shown that approximately 78% of patients reported improvement in pain within 15 minutes. - Sumatriptan subcutaneous injection (6mg): It is a fast-acting and proven acute treatment. - Sumatriptan nasal spray and zolmitriptan nasal spray are also used. ### preventive care During the cluster period, preventive treatment is administered to reduce the frequency of attacks. - Verapamil: The most well-evidenced preventive drug. Use under electrocardiogram monitoring. - Short-term prevention: Rapidly suppresses attacks with a short course of prednisolone in the early stages of an attack. - Lithium: Useful for chronic cluster headaches - Galcanezumab (anti-CGRP antibody injection): reported to be effective in preventing episodic cluster headaches ### neuromodulation treatment Non-invasive vagus nerve stimulation is used as an adjunct to acute and preventive treatment. A case in which hypothalamic deep brain stimulation (DBS) was performed for intractable chronic cluster headache has been reported. ## Frequently asked questions ### Q01What is the difference between cluster headaches and migraines? Migraines are mainly pulsating pain that lasts for several hours to several days and are accompanied by phobias of light and sound. Cluster headaches are severe pain around the eye on one side that lasts for 15 minutes to 3 hours, occur repeatedly at the same time (especially at night), and are accompanied by autonomic symptoms such as tearing, runny nose, drooping eyelids, and redness. Patients with cluster headaches tend to be restless and unable to sit still during attacks. ### Q02What should I do when I have a cluster headache attack? In most cases, inhalation of oxygen at 7 to 12 liters per minute for 15 minutes is the primary acute treatment. Sumatriptan subcutaneous injection (6mg) is also a very effective acute treatment. General painkillers are insufficiently effective, and the duration of the attack is short, so the attack often ends before the oral medication is absorbed. ### Q03Why do cluster headaches occur at certain times of the day? It is related to the regulation of circadian rhythm in the hypothalamus. Cluster headaches tend to start during certain seasons (spring and fall), especially during sleep at night. It is known that neural activation in the hypothalamus causes headaches through the trigeminal nerve-autonomic nerve reflex pathway. ### Q04Can cluster headaches be prevented? Preventive treatment is available to reduce the frequency and intensity of headache attacks during cluster periods. Verapamil (a calcium channel blocker) is the preventive drug with the best evidence, and short-term administration of steroids is used for short-term prevention. Lithium, topiramate, and galcanezumab (anti-CGRP antibody) are also used. ### Q05Does drinking affect cluster headaches? During a cluster attack, even a small amount of alcohol can be a powerful trigger that triggers a headache attack within tens of minutes. On the other hand, during the noncluster period (remission), alcohol often does not cause attacks. Therefore, it is recommended to completely abstain from drinking alcohol during the cluster period. ### Q06Are cluster headaches related to brain tumors? Cluster headaches themselves are not related to brain tumors. However, when a unilateral headache occurs for the first time, when the headache pattern changes, when it is accompanied by neurological abnormalities (limb paralysis, speech impairment, etc.), or when the diagnosis is unclear, secondary causes should be ruled out through imaging tests such as brain MRI. ## Related articles - giant cell arteritis - Hemicrania continua - Hypnic Headache - Idiopathic intracranial hypertension This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.