Cluster Headaches

Cluster headache (migrainous neuralgia)

This is much less common than migraine. Males predominate  5: 1, and onset is usually in the third decade of life. A cluster headache is called so because it generally lasts for several weeks to months. Moreover, it tends to occur seasonally, such as every spring or every fall. A cluster headache happens quickly, usually without any warning signs. Some people might experience migraine-like nausea and aura.

Common signs and symptoms of cluster headache are: 

  • Excruciating pain  generally in, behind (retro-orbital) or around one eye
  • Radiating to other parts of the face 
  • Unilateral pain 
  • Restlessness
  • Excessive tears 
  • Redness of your eye on the affected side
  • The runny nose on the affected side
  • Profuse sweating on the affected side
  • Drooping eyelid 


The exact cause and mechanism of cluster headache are unknown. But the cluster pattern of this type of headache suggests that it has something to do with the body’s biological clock (hypothalamus). Unlike other types of jeans, it is not associated with any particular food item. Other medications such as nitroglycerin are thought to trigger cluster headaches. 


Your doctor can diagnose cluster headaches due to the characteristic nature of the headache and the pattern of how it attacks. A detailed description of the attacks, location and severity of your pain and details of any associated symptoms will help your doctor diagnose it.  Based on your signs and symptoms, doctors will perform a general physical examination and neurological examination to assess your brain functions. They may advise some blood tests Moreover, imaging tests such as MRI and CT scan of the brain can be done as the last test to diagnose this headache or rule our tiger serious conditions. 

Cluster Headache Treatment

There is no permanent treatment for cluster headaches. Medications are used to decrease the intensity of pain, shorten the headache period and prevent further attacks. Following treatments are given to solve the acute attack of cluster headache: 

  • Oxygen 
  • Triptans 
  • Octreotide 
  • Local anesthetics such as lidocaine ‘
  • Dihydroergotamine

Moreover, the following medication can be used to prevent cluster headaches. 

  • Calcium channel blockers such as verapamil 
  • Corticosteroids such as prednisone 
  • Lithium carbonate.
  • Occipital nerve block 

Surgical options: 

In rare cases, when the cluster headache doesn’t go away, the doctor may have to advise surgical options which include: 

  1. Sphenopalatine ganglion stimulation 
  2. Noninvasive vagus nerve stimulation (VNS) 

Potential future treatments

Following treatment are under research and can be used in future: 

  • Occipital nerve stimulation
  • Deep brain stimulation
  • Trigeminal neuralgia
  • Unilateral lancinating facial pains
  • Severe,  very brief but repetitive pain
  • It causes the patient to flinch as it happens with motor tic. 
  • It can be triggered by touch.
  • It can appear and disappear again and again

Trigeminal Neuralgia Treatment

Trigeminal neuralgia usually resolves with medicines. However, if it does not, surgery may be performed. Following medicines are approved time used against trigeminal neuralgia. 

  • Anticonvulsant such as carbamazepine oxcarbazepine lamotrigine, phenytoin, clonazepam, and gabapentin 
  • Antispasmodic agents. such as baclofen 
  • Botox injections

Surgical Treatment

Following are the Surgical options for trigeminal neuralgia: 

  • Microvascular decompression
  • Brain stereotactic radiosurgery (Gamma knife)
  • Rhizotomy
  • Glycerol injection
  • Balloon compression
  • Radiofrequency thermal lesioning