Conditions

Cluster Headaches

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1. Introduction

Headache is the symptom of pain in the face, head or neck and, in general, they are not cause for concern. On average 37,000 people visit their general practice in the UK every day for headache related symptoms (1). On rare occasions certain types of headache are associated with other symptoms that may be suggestive of a more concerning condition. Please see the assessment and diagnosis section for symptoms that may require onward referral or investigation.

The International Headache Society classifies headaches into primary and secondary headache disorders (1, 2). Most headaches are ‘primary’ (approximately 90%). This means that the headache is not caused by any type of disease.

The three most common types of primary headache are:

  1. Tension-type headache (40%)
  2. Migraine (10%)
  3. Cluster headache (1-3%) (3,5)

Frequently Asked Questions

Cluster headaches begin quickly and without warning. The pain is very severe and often affects only one side of the head.

  • Headaches affect almost everyone at some time.
  • Cluster headaches are around twice as common in men than women (5).
  • No.
  • Headaches are generally a normal part of life and will commonly pass on their own.
  • Only around 2% of people seen in UK general practice with headaches are referred to a neurologist to rule out more serious causes (4).
  • Men.
  • Smokers.
  • Adults older than 20 years (2).
  • Cluster headaches begin quickly and without warning. The pain is very severe and is often described as a sharp, burning or piercing sensation on one side of the head (6). 
  • You may also get 1 or more of the following symptoms:
    • a red and watering eye 
    • drooping and swelling of one eyelid 
    • a smaller pupil in one eye 
    • a sweaty face 
    • a blocked or runny nostril (6) 

     

  • Visit your GP the first time you experience what you believe to be a cluster headache (7).
  • Consider using a headache diary to aid the diagnosis of primary headaches.
  • Consider causes/what you are doing during onset, intensity, area of pain, any other symptoms you experience whilst having a headache (this might be helpful in identifying triggers).
  • Finding any patterns may help your healthcare professional better manage your headache (6).
  • This is dependent on the cause and type of headache itself.
  • Many headaches will settle without concern however, some will require further investigation.

We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.

2. Signs and Symptoms

  • Pain will be one sided, around the eye, above the eye and along the side of the head or face.
  • Pain quality will be variable, it can be sharp, boring, burning, throbbing or tightening.
  • Severe or very severe intensity.
  • Cause agitation or restlessness during activities.
  • Red and/or watery eye.
  • Nasal congestion and/or runny nose.
  • Swollen eyelid.
  • Forehead and facial sweating.
  • Constricted pupil and/or drooping eyelid.
  • Lasts 15-180 minutes (1,2).
  • Episodic cluster headaches – 1 every other day to 8 per day, with remission more than 1 month.
  • Chronic cluster headaches – 1 every other day to 8 per day, with a continuous remission less than 1 month in a 12-month period (1).

3. Causes

The exact cause of cluster headaches is not clear, but they have been linked to activity in part of the brain called the hypothalamus. Some people who get cluster headaches have other family members who also get them, which suggests there may be a genetic link. Cluster headache attacks can sometimes be triggered by drinking alcohol or by strong smells, such as perfume, paint or petrol (1).

4. Risk Factors

This is not an exhaustive list. These factors could increase the likelihood of someone developing cluster headaches. It does not mean everyone with these risk factors will develop symptoms (1):

  • Men suffer twice as much as women from cluster headaches.
  • People who smoke are more likely to suffer from cluster headaches.
  • Adults older than 20 years of age.

5. Prevalence

37,000 people visit their GP with a headache each day in the UK (5). 1-3% of people who suffer from headaches experience cluster headaches (1).

6. Assessment & Diagnosis

Your GP will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established.  

Diagnosis into subtypes of headaches like cluster, tension and migraine comes from the symptoms, frequency and triggers you may experience. For people who present with headaches and any of the following features, further investigations may be considered (6): 

  • Worsening headache with fever. 
  • Sudden onset headache reaching maximum intensity within 5 minutes (thunderclap headache). 
  • New onset neurological deficit – loss of muscle strength, loss of feeling/sensation. 
  • New onset cognitive dysfunction – memory loss/confusion. 
  • Change in personality. 
  • Impaired level of consciousness – drowsy/fatigue/black out. 
  • Recent (typically within the past 3 months) head trauma/injury. 
  • Headache triggered by cough or sneeze. 
  • Orthostatic headache (headache that changes with posture). 
  • A substantial change in the characteristics of the headache. 

7. Self-Management

A diary may help you to find what triggers your headache and may help indicate if your GP needs to carry out further investigations. Keep a headache diary for a minimum of 8 weeks (1):

  • Frequency, duration and severity of headaches.
  • Any associated symptoms.
  • All prescribed and over the counter medications taken to relieve headaches.
  • Possible precipitants.
  • Relationship of headaches to menstruation.

Do not take paracetamol, NSAIDS, opioids, ergots or oral triptans for the acute treatment of cluster headache (1,6). Seek specialist advice if treatment for cluster headache is needed during pregnancy.

8. Rehabilitation

Rehabilitation will be determined by your symptoms and triggers. Recovery can take some time and should be managed by your GP. 

9. Cluster Headaches
Rehabilitation Plans

No specific rehabilitation exercises are advised and any treatment should be discussed with an appropriate healthcare professional such as a GP.  

10. Return to Sport / Normal life

Participating in sport or regular activities is safe if this does not cause or trigger symptoms.

11. Other Treatment Options

Any treatment should be discussed and managed with your GP. 

12. Links for Further Reading

Headaches: diagnosis and management of headaches in young people and adults; NICE Clinical Guideline (September 2012, updated December 2021)) 

Hale N, Paauw DS (2014) Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. The Medical Clinics of North America 98(3), 505-527. 

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References

  1. Headaches: diagnosis and management of headaches in young people and adults; NICE Clinical Guideline (2012)
  2. International Headache Society Classification of Headaches ICHD II; Updated Web-based Version
  3. Hale N, Paauw DS (2014) Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. The Medical Clinics of North America 98(3), 505-527.
  4. Mcneil, M. (2021). Headaches in adults in primary care. Medical Clinics of North America, 105(1), 39. https://doi.org/10.1016/j.mcna.2020.09.005
  5. Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol 2010;30:107-19.
  6. Suspected cancer: recognition and referral NICE guideline; (2015)  

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