Cluster Headache Symptoms

Many people still don't understand cluster headache symptoms, in spite of a growing amount of information on cluster.  Not only is there still a lot of information out there, new research has also added to our understanding of cluster headache and its symptoms.

What is a Cluster?

We can avoid a lot of confusion by explaining why we use the term "cluster".  Cluster does not refer to where the pain is, but when it is.

Cluster attacks most typically come in "clusters".  In other words, you'll get a series of attacks - once every other day, or several times a day - for a period of time.  Then you'll experience a time without any attacks at all.  The period of attacks is called a cluster series.

That's where the name comes from, but's it's important to remember that clusters do not always follow this pattern.  Many people, for example, only have one cluster series.  Others (about 10-15%) have chronic cluster, meaning that they never have periods of remission.

Typical Cluster Headache Symptoms

Symptoms do vary quite a bit from one cluster patient to another.  But to get started, lets talk about some typical cluster headache symptoms:

• Headache:  Severe or very severe pain, meaning that the typical cluster headache is more painful than the typical migraine attack.  Cluster headaches are often called suicide headaches because of the incredible pain.  However, the pain is often more or less severe at various times in a single patient.  The pain is usually one-sided, around or above the eye or in the temple.  It tends to get worse very quickly, reaching full power in 5-10 minutes.
• Eye Symptoms:  Other one-sided symptoms are most seen in the eye.  There may be a red eye, and/or the eyelid may droop.  There may be swelling around the eye.  The pupil may dilate (become smaller).  The eye may also water.
• Congestion:  The patient may become congestion on one side of the face, or even get a one-sided runny nose.
• Sweating:  Also one-sided, the patient may sweat on the face and forehead.  The face may look flushed or pale.
• Agitation:  Cluster headache patients usually feel very restless and agitated.  Most often they must move around and simply cannot stay still.  Pacing is common.

Attacks usually last between 15 minutes and three hours.  They may show up every other day (the least), or several times a day, often on a predictable schedule.  The attacks may not always get to the same level of pain, and they may be more or less frequent during the cluster series.

If this is not chronic cluster, the attacks may continue for days or weeks and then stop for a period of time (months or even years).

In chronic cluster headache, attacks continue for more than a year without remission, or with less than a month of remission.

Cluster attacks will often wake the patient up (which is why they have been called alarm clock headaches).

What can cause cluster headaches is still somewhat of a mystery, although we're learning more.

Oddities in Cluster Headache Symptoms

Patients may have some of the above symptoms, but not all.  But there are some other strange things about cluster headache symptoms that don't always fit the typical attack.

For example, some patients almost always have pain on the one side, while other patients have attacks on both sides at different times.  Or, in rare cases, the pain may switch sides.

Because the pain sometimes feels like it's coming from the sinuses, and because of the congestion symptoms, cluster has sometimes been misdiagnosed as a sinus issue.

In rare cases patients report symptoms of cluster without the headache.  Because cluster is rare, it may be some time before we know if these are true cluster attacks or a related issue.

In the end, although understanding these patterns helps with diagnosis, cluster headache symptoms are very individual.  Everyone is different.

For more, read the Mayo Clinic's article on Cluster Headache Symptoms.

Related Information...

Many people get confused about the differences between migraine symptoms and cluster headache symptoms.  For a quick comparison, read Cluster or Migraine: What's the Difference?

Hear a cluster headache survivor talk about his experiences here:  A Cluster Headache Survivor's Story

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References:  Typical traits of a cluster headache from ClusterHeadaches.com (1998-2011); WebMD Cluster Headaches (2010); MedlinePlus Cluster Headache (2010) Dr. Kevin Sheth; The International Classification of Headache Disorders 2 (2007) International Headache Society; Mayo Clinic Cluster Headache Symptoms (2011)