Cluster Headache

What is Cluster Headache?

Cluster headache is a rare primary headache disorder with attacks of severe one-sided pain and eye and nose symptoms on the same side. It belongs to a group called trigeminal autonomic cephalalgias and is regarded as one of the most severe headaches.^[1] For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Attacks cause intense pain around the eye, above the eye or at the temple, lasting 15 to 180 minutes and occurring from every other day up to eight times a day.^[2] On the same side there is usually a watering or red eye, a stuffy or runny nose, a drooping eyelid, eyelid swelling or facial sweating, and many people feel agitated and unable to lie still.^{[2, 3]}

• Attacks that often strike at the same time of day, most often at night
• Bouts lasting weeks to months, followed by remission for months or years in the episodic form^[1]
• Nasal symptoms that can lead to a mistaken diagnosis of "sinus headache"^[1]

Causes and risk factors

The exact cause is not known. Research points to the hypothalamus, a brain area that regulates body rhythms, as the generator of the pain and the autonomic symptoms.^[3] Genetics play a role, since first-degree relatives are far more likely to be affected.^[1] It is more common in men and usually starts around age 30.^[2] Alcohol, nitroglycerin, foods with nitrates and strong odors can trigger attacks during a bout.^{[2, 4]}

How it is diagnosed and treated conventionally

Diagnosis rests on the pattern of symptoms, after other primary and secondary headaches are excluded.^[3] It is treated by a physician, often a neurologist.

For attacks, the European guideline strongly recommends 100 percent oxygen and injected sumatriptan. Verapamil is recommended to prevent attacks, with corticosteroids, nerve blocks, lithium, topiramate and, for episodic cluster headache, galcanezumab as other options.^[5] Non-invasive vagus nerve stimulation helps episodic but not chronic cluster headache.^[5] Decongestants do not work for cluster headache.^[1]

Why Cluster Headache calls for a whole-person approach

Cluster headache is a brain disorder, so medical treatment must come first and be directed by a specialist. The attacks are severe, strike at night and come in bouts, so they affect sleep, mood and daily life, and supportive care can address these effects.^{[1, 3]}

Nothing on this page suggests that supportive care can stop attacks. It focuses on how a person copes while their physician treats the disorder.

The hypothalamus and body rhythms

The hypothalamus, a brain area that helps control daily rhythms, is implicated as the generator of cluster headache pain.^[3] Attacks often occur at about the same time of day, most often at night.^[1]

Sleep disruption

Attacks tend to occur at night, so sleep is often broken.^[1]

Triggers during a bout

Alcohol can trigger cluster attacks, and so can nitrates and strong odors, so identifying personal triggers with your physician is part of care.^{[2, 4]}

Pain-related stress

The pain is excruciating, and the attacks are unpredictable.^[3] Stress and sleep loss are therefore reasonable targets for supportive care.

Acupuncture as supportive care in Cluster Headache

What the research shows

No controlled trial of acupuncture for cluster headache was found, so we cannot say it reduces attacks. A published case series described four patients who received a 12-week acupuncture course, alone or with verapamil, and who all had their attacks interrupted. Four patients without a comparison group cannot show that acupuncture caused the improvement, since cluster headache comes in bouts that end by themselves.^[6]

A separate case report noted that acupuncture has not generally been successful for cluster headache and described one patient treated with a trigeminal approach.^[7] A BMJ review of complementary medicine for headache found that complementary approaches have either not been studied or are not effective for cluster headache, though traditional Chinese medicine and acupuncture had positive effects on migraine and tension-type headache.^[8]

For the general effects of stress and poor sleep, there is better evidence from other conditions. A review of 24 trials of acupuncture for insomnia pooled 15 that compared it with medication and found better sleep scores from about 3 weeks of treatment, though results varied widely between studies.^[9] That evidence concerns insomnia in general, not cluster headache.

How acupuncture may work

How acupuncture might act in cluster headache is not known. The authors of the four-patient series suggested a possible influence on the body's opioid system, but this is speculation, not a tested mechanism.^[6]

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. A course is several visits with reassessment. The four-patient series used treatment twice weekly, then weekly, over about 12 weeks.^[6] Any sessions would aim at stress, sleep and general well-being and would be timed around your medical care.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Cluster Headache

The Ayurvedic view

Ayurveda describes severe, one-sided headaches with pain around the eye under names such as Suryavarta and Ardhavabhedaka, which are traditionally considered Vata, Pitta or combined disorders. These are traditional categories and are not equivalent to cluster headache, which is diagnosed medically from its pattern of symptoms.^[3]

Therapies that may be used

Supportive care is chosen for the individual and is gentle:

• Regular daily routine and consistent sleep and wake times
• Calming practices such as breathing exercises and meditation
• Warm oil massage of the feet or shoulders, avoiding the face and head during a bout unless your physician agrees
• Herbs only after review of your medicines by a qualified practitioner

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is not suited to a severe bout of attacks.

What the research shows

There is no research on Ayurvedic medicine for cluster headache, and a BMJ review found that complementary approaches have not been studied or are not effective for it.^[8] A PubMed search for cluster headache with Ayurveda, Panchakarma or herbal terms found no clinical trials, case series or reviews. Any benefit would be limited to general relaxation and routine, and Ayurvedic care cannot be said to prevent or relieve attacks.

Herbal medicine as supportive care in Cluster Headache

Herbs and formulas that have been studied

No herb or formula has been tested in a clinical trial for cluster headache in the studies we found. The BMJ review found that complementary approaches have not been studied or are not effective for cluster headache.^[8] Melatonin is listed among the preventive medicines physicians may use, and it should only be used under your physician's direction.^{[2, 11]}

What the research shows

The evidence for herbal medicine in cluster headache is none. We cannot say any herbal preparation reduces attacks. Herbs may be used for general goals such as sleep and stress only when your physician agrees.

Safety and herb-drug interactions

Herbs are active substances and can interact with prescription medicines, including some used for cluster headache.^[12] Case reports describe bleeding when warfarin was combined with herbs including dang gui (Angelica sinensis), dan shen (Salvia miltiorrhiza), ginger, ginseng and Boswellia.^[13] Your full medicine list, including verapamil, lithium or triptans if you take them, should be reviewed with your prescriber before any herb is considered.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[14] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes severe one-sided head pain as blockage of qi and blood in the channels of the head, sometimes with heat or liver-related patterns. Researchers describe cluster headache in terms of the hypothalamus, the trigeminal nerve and the autonomic nervous system, which is a different framework.^{[3, 15]}

Ayurveda's aggravated Vata or Pitta describes severe pain with a time-of-day pattern. No study has shown that a dosha or a pattern corresponds to a specific biological process.

How this care fits with your medical care

Supportive care does not treat cluster headache. Keep your physician or neurologist, and do not stop or change prescribed medicines, oxygen or injections without your prescriber. Effective treatments exist, so a diagnosis from a physician matters.^{[5, 11]}

Please bring your diagnosis, a list of your attack treatments and preventive medicines, and any notes from your neurologist. We do not diagnose headache disorders.

When to seek urgent medical care

Some headaches signal a more serious problem, and cluster headache is diagnosed only after other causes are excluded, so a new pattern needs prompt evaluation.^[3]

• A sudden, severe headache that is the worst of your life or unlike your usual attacks
• Headache with fever, a stiff neck or a rash
• Weakness, numbness, confusion, trouble speaking or seeing, or fainting
• Headache after a head injury
• Attacks that no longer respond to your usual treatment, or that change in pattern
• Thoughts of harming yourself because of the pain

If any of these occur, call 911 or go to the nearest emergency department.