Causes of cluster headaches

Cluster headaches are the least common--and most severe--type of primary headache. The pain of a cluster headache is intense and has a burning or piercing quality that can be either throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster" refers to the characteristic grouping of attacks: Headaches occur one to three times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

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Cluster headaches affect fewer than 1 in 1,000 people. They are a young adult's disease; headaches typically start before age 30, are rare in children under 10, and are uncommon in teens. The headaches appear to be far more common in men than women.

The true biochemical cause of cluster headaches is unknown. However, the headaches occur when the trigeminal nerve, the chief sensory nerve of the face, is activated and causes the eye pain associated with cluster headaches. The trigeminal nerve also stimulates the parasympathetic autonomic system, which causes the eye tearing and redness, nasal congestion, and discharge associated with cluster attacks. Cluster headaches appear to be generated by the part of the brain known as the hypothalamus. Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack.

Researchers believe that histamines, which dilate or expand blood vessels, influence the onset because during a cluster headache, the level of histamine increases in a person's blood and urine.

Cluster headaches usually are not caused by an underlying condition such as a tumor or aneurysm.

Because cluster headaches often occur in the spring or autumn, they are often mistakenly associated with allergies or business stress. The seasonal nature of cluster headaches most likely results from stimulation or activation of the hypothalamus.

Cluster headaches are also common in people who smoke and drink alcohol frequently. During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods the patient can consume alcohol without provoking a headache. Smoking can also increase the severity of cluster headaches during a cluster period.