Cluster headaches are severe headaches that occur in groups (clusters) followed by a period of time without headaches. This headache occurs predominantly in men. The onset of this headache syndrome occurs at ages 30-40. The headache is not hereditary.
The headache usually occurs after a period of sleep. It has a seasonal preponderance, occurring usually in the spring and fall. Cluster headaches may occur several times a day during the attack and last about an hour. The headache is usually felt behind the eye or around the temple. Sympathetic nervous system involvement is evidenced by ptosis (droopy eye), miosis (small pupil), redness of the eye, tearing and nasal congestion. The pain of cluster headache is severe and the patient usually is unable to sit still or lie down. Although there is no specific test for cluster headache, an MRI of the brain is needed to exclude any intracranial pathology. Treatment of cluster headaches need to be individualized, but may include oral steroids, 100% oxygen by mask, lithium carbonate or sphenopalatine ganglion blocks.