Headaches, Cluster

Cluster headache (CH), also known as histamine headache, is a specific vascular headache syndrome and one of the most severe forms of headache. The underlying cause is still poorly understood but it is thought that the pain may be related to the dilation/alteration of blood vessels or to inflammation of nerves behind the eye.

CH affects approximately 8-10% of all persons who suffer from headaches. They most commonly occur in men (six times more frequently than in women) between the ages of 20 and 40. They are observed more frequently among those who smoke and consume alcohol. Each headache episode generally lasts from fifteen minutes to three hours. Many such episodes may occur during a day. They tend to occur in cycles, often during the months of the year that are warmer and have more daylight. Persons who suffer from CH tend to be sociable, active and responsible and, for this reason, CH are sometimes called “the executive headache”.

Only the CH victim can understand the excruciating pain and discomfort that characterize this disorder. Fortunately, only a small percentage of CH cases complain of the chronic form. Chronic CH is distinguished by its lack of a remission period lasting more than 14 days, or the absence of a remission period for more than one year.

The telltale signs of a cluster headache are distinct yet remarkably similar among CH sufferers everywhere. Here is a list of commonly reported symptoms associated with this condition:

  • A piercing, stabbing pain on one side of the head and behind the eye
  • Attacks occuring in clusters lasting several weeks, with a remission period of months or years between headache episodes
  • Several headaches daily, recurring at the same time each day, often awakening one from sleep
  • The inability to lay down or remain still
  • Eye region becomes droopy, red and moist
  • The nostril on the affected side becomes stuffed and runny
  • There is the desire to pound one’s head against a wall
  • Feelings of dejection, anxiety and irritability.

Many sufferers report that they have been to numerous doctors, neurologists and other specialists over a period of years, prior to being accurately diagnosed. In addition to their pain, they have incurred great frustration in seeking answers to their little-known condition, as well as untold expense, and have been subjected to a number of inappropriate treatments.

Treatment of CH generally aims at prevention of the attacks. Since CH generally appears over several days at around the same time each day, it is possible to prevent these headaches by taking timely remedies.


Signs, symptoms & indicators of Headaches, Cluster

Symptoms - Metabolic  

Current atypical recent headaches

Cluster headache is usually localized to the ocular and retroocular region, whereas migraine tends to involve the entire hemicranium.

Recommendations for Headaches, Cluster


Cayenne Pepper (Capsicum frutescens)

Capsiacin cream has a significant success rate reported from one study where three applications (in a liquid form) per day were placed in the nose on the affected side. A significant downside must be that cayenne pepper in the nose has to hurt!


Alcohol Avoidance

Alcohol use may trigger attacks.


Caffeine/Coffee Avoidance

When painkillers or caffeine are taken daily, the drugs may lose effectiveness over time and headaches can become more frequent. When stopping the medication, a rebound headache can occur. Rebound headaches are frequently caused by dietary caffeine.

Both migraine and cluster headaches are associated with heavy caffeine intake, and caffeine withdrawal can cause a headache resembling a migraine. However, many people find that caffeine will help reduce the severity of a cluster headache. In some of these cases it is suspected that heavy use, temporarily suspended, causes a headache which can be aborted by renewed caffeine consumption. Caffeine is a constrictor of dilated arteries and should best be avoided as a dietary staple in vascular headaches.


Conventional Drugs / Information

Subcutaneously injected sumatriptan (6mg in 0.5ml) (Imitrex in the US) is the most effective, reliable, and rapid abortive therapy for cluster headache attacks. An injection (easily given by the patient) eliminates or markedly diminishes cluster headaches within 15 minutes in essentially all patients at every attack. Some patients have had headaches eliminated in as little as 7 minutes. This effect does not lessen with continued use. Some patients have had satisfactorily rapid results with sumatriptan nasal spray. The oral triptans are less effective, but some especially good responders with relatively milder and slower-developing headaches may prefer this route of administration.


Tobacco Avoidance

A very strong association exists between smoking and cluster headaches.


Aerobic Exercise

Vigorous physical exertion at the earliest sign of an attack can, in some patients, be remarkably effective in ameliorating or even aborting an attack. [Atkinson, 1977; Ekbom and Lindahl, 1970]



A drop in nocturnal melatonin has been linked with cluster headaches, and melatonin supplementation has shown a low but significant preventive capacity for cluster headaches. In a blinded trial, 10mg of melatonin was given to 10 subjects and a placebo was given to 10 controls for 14 days. 5 out of 10 treated patients reported a decline in attack frequency after 3-5 days of treatment and then experienced no further attacks until melatonin was discontinued. The melatonin was taken in a single evening dose. [Cephalalgia. 1996;16: pp.494-496]



People who suffer from cluster headaches often have low blood levels of magnesium, and preliminary trials show that intravenous magnesium injections may relieve a cluster headache episode. Magnesium is a relaxant of smooth muscles. [Headache 1995;35: pp.597-600, 1996;36: pp.154-60]


Lithium (low dose)

Lithium carbonate, orotate or aspartate has been found to be effective in treating chronic cluster headaches, possibly due to its ability to impact the electrical system within the brain. The usual dose for the carbonate form is 300mg 2-3 times daily. Lithium levels should be checked and kept within, or even slightly below, the therapeutic range for bipolar disorder, namely 0.5 to 1.5 milliequivalents per liter.

One study examined lithium’s effects on 19 men with cluster headaches. Eight had rapid improvement ( 85% reduction) in their “headache index” in just two weeks. Four individuals had both cluster headaches and psychiatric symptoms; these four had almost complete elimination of their headaches. The remaining seven had only a slight benefit. Another research group tried lithium therapy (again, relatively high quantities) for 14 individuals with cluster headaches. Five individuals had complete disappearance of their headaches, four had significant improvement, and four had no change.

Oxygen / Oxidative Therapies  


Breathing pure oxygen (by face mask at a flow rate of 7 liters per minute for 15 minutes or less) provides considerable, rapid relief to most cluster headache sufferers by relaxing constricted blood vessels and thereby raising blood-oxygen levels. This treatment is both effective and safe, benefiting the majority of patients who use it.


Oxygen, Hyperbaric

Hyperbaric oxygen is said to help cluster migraines. [Headache 1995;35: pp.260-61]


Strong or generally accepted link
May do some good
Likely to help
Highly recommended


Cluster Headache

A headache in which pain originates behind or around one eye and generally awakens the individual from sleep; pain may radiate into the temple, jaw, nose, teeth, or chin; the eyelid droops, the eye tears, the face flushes, and the nose congests; causes excruciating pain. Individual headaches last 15 minutes to 3 hours but tend to "cluster", occurring up to several times per day for periods of about 1 to 16 weeks and then not again for months or years.


A chemical in the body tissues, produced by the breakdown of histidine. It is released in allergic reactions and causes widening of capillaries, decreased blood pressure, increased release of gastric juice, fluid leakage forming itchy skin and hives, and tightening of smooth muscles of the bronchial tube and uterus.


Usually Chronic illness: Illness extending over a long period of time.


454 grams, or about half a kilogram.


Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.


Not just a headache, but a disorder affecting the whole body, characterized by clearly defined attacks lasting from about 4 to 72 hours, separated by headache-free periods; progresses through five distinct phases. Prodrome: experienced by about 50% of migraineurs and starting up to 24 hours before the headache - changes in mood, sensory perception, food craving, excessive yawning, or speech or memory problems. Aura: experienced by about 15% and starting within an hour before the headache - disruption of vision (flashing lights, shimmering zigzag lines, blind spot) or sensation (numbness or 'pins and needles' around the lips or hand), or difficulty speaking. Headache: usually pulsating and occurring on one side of the head, it may occur on both sides of the head and alternate from side to side. Muscles in the neck and scalp may be tender; there may be nausea and the desire not to eat, move, see or hear. Resolution: the headache disappears and the body returns to normal. Resolution may occur over several hours during sleep or rest; an intense emotional experience or vomiting may also end the headache. Postdrome: After the headache stops, the sufferer feels drained, fatigued and tired. Muscles ache, emotions are volatile and thinking is slow.

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