Cluster Headaches : The Clockwork Agony
- Yoon Shwe Yi Han
- 5 days ago
- 3 min read
Headaches are one of the most common conditions almost everyone has experienced, whether from a stressful day at work, lack of sleep, or certain foods. Although some headaches can be manifestations of other health issues, they could also be standalone conditions. Therefore, headaches are generally classified in two types -
Primary headache : Caused by dysfunction or over-activity of pain-sensitive features in head
Secondary headache : Caused by an underlying medical condition
What is Cluster Headache?
Cluster headache is a type of primary headache. Although rare, it is more commonly seen in men than women. It typically causes intense pain in or around the eye on one side of the head. Attacks are relatively short, typically lasting for 15 minutes to 3 hours, but people can experience up to 8 of these headaches within 24 hours.
The name "cluster headache" comes from its cyclical pattern. Headaches usually recur at the same time each day over weeks to months. After an attack, it usually takes a few months and sometimes, years before the second attack. This pain-free period is known as remission and this type of headache is called Episodic Cluster Headache. However, 1 in 5 people experiencing cluster headaches do not experience this remission period and thus have Chronic Cluster Headaches.
Attacks often strike at night, typically one to two hours after falling asleep. The pain is so severe it can wake a person, which is why cluster headaches are sometimes called Alarm Clock Headaches.
Common symptoms
Cluster headaches often emerge with no warning. However, for some people, they might experience migraine-like nausea and aura beforehand. In addition to the excruciating pain, other symptoms also occur on the same side of the head as the pain, including:
Watery eyes
Eye redness
Droopy eyelid
Runny nose
Forehead or facial sweating
The pain typically feels sharp and stabbing, often accompanied by a burning sensation. It is so intense that most people feel unable to sit still and are often restless or agitated during an attack.
Causes and Risk Factors
Despite the severity, the exact cause of these cluster headaches is unknown. It is best to be familiar with the risk factors which includes:
Age between 20 - 50
Male
Smoking
Alcohol use
Family history
Managing and treating cluster headaches
The treatment options for cluster headaches includes medications to prevent headaches and medications to manage the pain.
For preventive medications, common medicines for allergies, depression, blood pressure and seizures can shorten the headache cycle.
For pain management, certain medicines like triptan (sumatriptan), anti-inflammatory medicines (steroids like prednisone) or dihydroergotamine injections (can't be taken with sumatriptan) can be used. NSAIDs such as ibuprofen, paracetamol are not helpful to treat cluster headaches.
Breathing 100% oxygen can also relieve symptoms during an attack.
However, if the medications are not helpful, surgery can be an option to implant neurostimulator device. This device will send electrical signals to certain nerves in head for symptoms management.
Recognize, Diagnose, and Act
In summary, cluster headaches are defined by their brutal, clockwork-like attacks. If you suspect you or someone you know has cluster headaches, seek medical evaluation immediately. Do not rely on standard painkillers, as they are ineffective. With targeted preventive and acute treatments, it is possible to reduce the frequency of attacks and manage the pain, restoring quality of life.
References
Cleveland Clinic (2023) https://my.clevelandclinic.org/health/diseases/5003-cluster-headaches
Mayo Clinic (2025) https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080
Cleveland Clinic (2022) https://my.clevelandclinic.org/health/diseases/9639-headaches
Assessed and Endorsed by the MedReport Medical Review Board
