Hi JPO

What you need to do is to work with a headache specialist to get a definitive diagnosis which will open up the path to getting the correct treatment. This is a complex area of medicine as there are multiple other possible causes of headaches that mimic cluster headaches, so it needs someone with the appropriate skills and experience to get this right.

Probability that you have Cluster but there are a number of conditions which mimic Cluster and which are rathe serious. Hence, need for a skilled doc to sort thru the jumble--headache specialist being the best bet in terms of knowledge/skill/experience.

Stress may a trigger for some but is not the cause. Core issue is a jumble in our hypothalamus--nothing which be cured at this state of knowledge. So, good mix of appropriate meds/other treatments will give a high chance of good control.

Learning about them is a primary protection. Explore the buttons, left, starting with the OUCH site. Then,




Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
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Print the PDF file, below. These are the most commonly used meds for Cluster, along the evaluation of effectivenss. Use it as a tool to discuss options with the doc. If he isn't working from this group, need to reconsider his skill.
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You can print out relevant sections from this pub, written by one of the better headace docs in the U.S.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
ALL NEW!! HEADACHE 2010-2011
Robbins Headache Clinic

Free, 50-page. Covers all major headache Dx and
related issues.

In a PDF file.
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Avoid OTC pain meds (you experienced the limited knowledge of the ER doc---all too common there.) Pain meds will not relieve and, with much use, will increase frequency of attacks. TOTALLY avoid alcohol as long as you are having this kind of headache; avoid solvents and potent cleaning agents--they will trigger Clusters for many, especially alcohol.
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Read here regularly. You will find youself in many messages and gain comfort in seeing that the vast majority of us live good lives and learn how not to be afraid.

Keep us abreast of your progress.

I had to laugh a little when I read your post. Your doctor seems to know nothing about CH. I would strongly urge you to go to a headache clinic. If you look in the links there are many great clinics that specialize in headaches and will get you on the correct treatment for this. I myself had to see 5 doctors before I was diagnosed in a HA clinic. Also o2 o2 o2 o2 and probably get used to needles

I neglected to mention: when starting a new experience of (what may be) Cluster, it's very common for symptoms to vary widely before settling down to a stable picture. This shifting may go on for months, even a year or more.

That being the case, I'd suggest that you see a good headache doc now rather than assuming the current bout will stop and not recur.

The advantages: establishing a working relationship with a new doc even if you don't need regular attention right now; developing a treatment plan now so that you can put it into motion at the first sign of another cycle starting (beats having to wait weeks to get an appt).

It's so uncommon to have only one Cluster bout in a lifetime that the odds are that you will be starting this whole process in the near future.

JPO wrote on Apr 23^rd, 2012 at 4:06pm:


No, it couldn't hurt particularly if you need an eye exam anyway. But it isn't likely to help. And before you go getting any teeth pulled, we've gone down that road before and it's a nonstarter for us.

The symptoms you describe for the rest of the day do not sound particularly related to clusters as far as I'm concerned. Still, others may follow who say that's just what they experience. So much is individually biased when it comes to CHs. Get that appointment soonest. It's a bad idea to self diagnose any pain, never mind head/eye pain. Too many other things can be in play. God bless. lance