What are cluster headaches (Horton's headache)?

Facts about cluster headaches

Cluster headaches, also called Horton's headache, affect approximately 1 in 1000 people, and about four times as many men as women.

Cluster headaches most often start between the ages of 20 and 40, but can also occur in children. There is also a certain hereditary component to Horton's headache.

The clusters typically last 1-3 months, with attacks occurring several times a day. There can be months or years between these clusters, and you are usually symptom-free in between.

About one in five people with cluster headaches develops a chronic form, without long breaks between attacks.

The pain during an attack is often described as unbearable, which has earned it the nickname "suicide headache."

At times, you may be bothered by so-called "shadow attacks," which are discomforts rather than pain in the area where the attacks are usually localized.

Horton's headache cannot be diagnosed with blood tests, scans, or similar, so the diagnosis is made solely based on the description you provide as a patient.

Having cluster headaches can be very debilitating, but it is not dangerous and the brain does not suffer damage.

Symptoms of cluster headaches

• Hyper-intense, boring, burning pain localized in or around one eye. The pain is often described as a "knife being twisted around"
• The pain is accompanied by a runny or stuffy nose.
• The eye may become red and watery, and the eyelid may droop.
• The pain has a rapid onset and typically lasts 15-90 minutes, sometimes up to 3 hours or more
• You may have 1-8 attacks per day, some even more. The attacks often occur at night.
• During attacks, you usually become agitated, restless, or, for example, sit and rock back and forth. You may become irritable or even aggressive.

Treatment options for cluster headaches

Although no cure for cluster headaches has been found yet, there are several treatment options to alleviate symptoms and reduce the frequency and intensity of the attacks.

Acute treatment for cluster headaches

• Oxygen inhalation via a tight-fitting mask, where inhaling 12-15 liters of pure oxygen for 15-20 minutes can provide pain relief.
• Triptans, typically sumatriptan as an injection or nasal spray, can have a rapid and soothing effect on the pain.
• There is usually no effect from painkillers such as paracetamol and ibuprofen or morphine preparations.

Preventive treatment for cluster headaches

Preventive treatment is used during clusters to mitigate and reduce the frequency of attacks.

• Verapamil is the first-line medical choice for preventing cluster headaches and is taken daily throughout the cluster period. The dosage is individual.
• Candesartan, Lithium, and Gabapentin are also medications that can be effective in some cases.
• A 10-day course of Prednisolone can be used as a transition to achieve rapid relief before the effect of other preventive treatments sets in.
• GON blocks can prevent attacks and may be effective for up to 3 months in some patients.

Lifestyle changes can help with cluster headaches

There is no research evidence regarding the effect of lifestyle changes on cluster headaches, but experience shows that heat, alcohol, and smoking can be triggering factors.

If you experience symptoms of cluster headaches, you should seek professional medical help for targeted treatment.