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The cause of these rare headaches are not well understood. Because of the symptoms that accompany the headache and their cyclical nature, it appears that they are related to an underlying problem with the autonomic nervous system, particularly a part of the brain called the hypothalamus. Although it is not known what sets off a cluster attack, there appears to be some association with certain hormones and neurotransmitters. During a cluster period, alcohol is a common trigger which sets of headaches.

Although the exact cause of cluster headache is not known, there are some known risk factors that increase one's risk of having this condition:

• Adult age: Although cluster headaches can develop at any age, it is most common to affect adults from their late 20's on.
• Male Gender: Men are much more likely than women to develop cluster HAs.
• Ethnicity (African American): African Americans are more likely than caucasians to experience these headaches.
• Family History: People with first degree relatives (sibling or parent) with these headaches are at a higher risk of developing them themselves.
• Smoking and Drinking: Many cluster headache sufferers are smokers and in people who have a history of these headaches alcohol can trigger attacks.

What Types of Symptoms Are Typical?

These other symptoms (tearing, swelling, pupil changes, stuffy nose, etc.) all suggest an autonomic nervous system source for the symptoms.

How Is The Diagnosis Typically Made?

Because the pattern of the headaches is so characteristic, doctors will often ask sufferers to make a diary or journal of their headaches, to look back and see if they fit a typical pattern of clusters. For example, the patient is asked to write down every time they have a headache and to describe the pain, the severity, the location, the duration, any inciting factors (alcohol, medications, etc.), the time and date, etc. This type of journal alone can go a long way to helping make the diagnosis.

What Are Some Common Treatments?

Some examples of acute treatments that are given once an attack starts:

• Oxygen: When at home, inhaling 100% oxygen from an oxygen tank often helps alleviate the symptoms of an attack. This is obviously more difficult to use away from the home because the large oxygen tank and mask must be with you.
• Triptan medications: There is a class of drugs called triptans (all the names end in -triptan) that are most commonly used to treat migraine headaches. These drugs also help some people control cluster headaches. The fastest acting form are the injectable forms of sumatriptan (Imitrex) although nasal spray forms can also be used. There is also a nasal spray form of zolmitriptan (Zomig).
• Dihydroergotamine: Another medication used for migraine, this medication can also be prescribed in injectable, IV and inhalation forms.

• Octreotide: Sandostatin or octreotide is a hormone and neurotransmitter which is effective as an injection for many patients with cluster HAs.
• Local Anesthetics: Local anesthetics are numbing medications such as lidocaine and can be effective as nasal drops.

Other treatments are rarely suggested for patients who don't respond well to the medications mentioned above. They can attempt to control the ocurrence of headaches in the first place. For example, surgical treatments, either open surgical or injections can be used to treat the nerves at the base of the brain which appear to be associated with the headaches. Likewise, some preventative medicines may be prescribed during cluster periods to help reduce the severity and frequency of headaches. Examples include short courses of corticosteroid medications (such as prednisone), ergotamine or nerve blocks. Other longer-term medications may be prescribed, such as calcium channel blockers (such as verapamil) or lithium. Less commonly, anti-seizure medications such as divalproex and topiramate may be used