Cluster headache is among the most severe pains known to mankind. It is characterized by excruciating, debilitating pain lasting from 15 minutes to three hours, and occasionally longer.  The pain is usually located around or through one eye, or on the temple.  Attacks usually recur on the same side of the head.  Cluster headaches tend to occur more in spring and fall.  There is usually no family history of cluster headache. 

Males are predominately afflicted, in a 4:1 ratio to females.  The onset of the clusters is usually between age 20 and 45, but there are cases of cluster headaches in teenagers, and occasionally clusters begin after age 50, though rarely after 70.  Women tend to have an older age of onset for their clusters than men. 

The pain of the cluster attack is extreme and starts very quickly, usually without an aura or a warning.  Within minutes, it becomes very severe.  Although the pain is usually located about the eye or temple, it may be more intense in the neck or facial areas.  The pain is sharp, and stabbing, having been described as “like my eye is being pulled out.”

In managing the clusters, we keep in mind the fact that the clusters build and then peak, and I often treat them with somewhat less medication, particularly corticosteroids, in the beginning of a cluster period.  The natural history of cluster is unknown; however, it appears as if the longer people have had them, the more likely they are to abate.

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