Cluster headaches

What are cluster headaches?

Cluster headache is a rare headache disorder characterised by recurring bouts of excruciating pain on one side of the head.

It has been described as one of the most painful conditions known to man. The intense pain is often reported to give rise to suicidal thoughts, and is sometimes called ‘suicide headache’.

Most patients have episodic cluster headache, characterised by bouts (or “clusters”) of headache that last from four to 12 weeks. The patient will typically then have a headache free period of several months or even years before the onset of another cluster. Around one fifth of patients do not have the pain free intervals and are said to have chronic cluster headache.

During the bouts of headache, the frequency of attacks may vary from one attack every few days to multiple attacks per day. Each attack may range from 15 minutes to several hours.

Cluster headache impacts heavily on the lives of patients, causing multiple admissions to hospital, restricting people’s lifestyles and often leading to unemployment. It is associated with a threefold increase in risk of depression and suicidal tendencies are often reported.

Who is affected?

Cluster headache is rare, affecting around one in 1,000 people.

It usually onsets after the age of 30 years.

Males are four times more likely than females to develop cluster headache.

Treatment

While there is no cure for cluster headache, there are currently two different approaches to treatment – acute treatments and preventive treatments.

Acute treatments aim to stop the pain during an attack. This is difficult because the pain becomes extremely severe very quickly. Oxygen is one of the safest and most effective ways to treat an attack. Drugs called triptans can also reduce the pain of an attack.

Preventive drugs are designed to be taken when a bout of headaches starts and aim to stop the onset of attacks. Surgery is also an option for some people who do not respond to medication. Two procedures – deep brain stimulation and occipital nerve stimulation have been used with some success in cluster headache patients.

None of these approaches represents a cure, but alleviate some of the symptoms of cluster headache.

How do we help?

Brain Research Trust provided funding to help introduce deep brain stimulation at the National Hospital for Neurology and Neurosurgery in London. This technique is proving successful in the treatment of a number of neurological conditions including cluster headache, Parkinson’s disease, epilepsy and dystonia. We continue to fund research to help refine and advance use of the technique and are currently funding a project by Dr Ludvic Zrinzo, testing the use of advanced neuroimaging techniques to improve safety and efficacy in patients undergoing DBS.

In 2017, we awarded a Brain Research Trust PhD studentship to Dr Emer O’Connor at the UCL Institute of Neurology to enable her to pursue her research in cluster headache. She first encountered patients with cluster headache during her medical training and was struck by the impact of the disorder on the lives of those affected.