Cluster Headaches


Article by J. MillerS.Armfield

What are Cluster Headaches? 

Cluster Headache

Cluster Headache sufferers tend to report their pain as being the worst imaginable, and these are often considered the worst of the primary headache disorders. Such is the pain that Cluster headache sufferers can be suicidal.  

Cluster headaches tend to start in people in their late twenties and are the only headache more common in men than women.

What are the Symptoms of Cluster Headaches?

Sufferers will also experience swelling of the eye and congestion of the nasal passage on the affected side. Some people also experience facial sweating and agitation. Cluster headaches are named from their pattern of occurrence.  

cluster headaches

Sufferers will tend to have daily headaches from between 3 to 6 weeks. Cluster headaches are side-locked, meaning they always present on the same side, even after a long remission. The headaches will last between 15 minutes and 3 hours. The headaches will then go into remission for up to a year before another ‘cluster’ occurs.

How are Cluster Headaches Diagnosed?

There is no one specific test that identifies cluster headaches. Your diagnosis will be made based on your health professional's interpretation of your symptoms and how you respond to different treatments. Your may refer you to a Neurologist who will clarify your diagnosis.

What about X-rays, CT-scans and MRI?

Unfortunately X-rays, CT-scans and MRI's are not diagnostic of a cluster headache. 

However, X-rays and scans may identify structures that could potentially be causing your headache. We recommend that you have at least cervical spine X-rays if you have been suffering headaches or head pain for any extended period.

Mixed Headache-Migraine Types

There are over 300 sources of headache, and cluster headaches are reasonably uncommon. Unless your symptoms identify you as a likely cluster headache sufferer it is more liekly that you are suffering from another headache or migraine source.

You may also be suffering from a mixed or multi-source headache. In these instances, your neck headache may be solved but another source of your head pain could linger.

Your physiotherapist will advise you if you have symptoms that could indicate a different cause for your headache. In these instances, they will also direct you towards further investigations or tests that may assist your diagnosis and subsequent treatment.

You can simultaneously suffer one, two or more types of headache or migraine.

One type may cause another or overlap with another. For example, a painful neck can cause an increase in muscular tension, which will increase your blood pressure. In this scenario, you would be suffering a neck headachetension headachemigraine!

tension type headache

In our experience, finding the primary source of your headache or migraine is the key to successful management.

What Else Could Be Causing Your Headaches or Migraine?

Your physiotherapist and doctor will be able to assist your diagnosis and headache source. Sometimes specific tests can confirm your diagnosis. On other occasions it can be by a process of elimination.

In a small percentage of patients there is unfortunately a sinister cause of your head pain, which should be thoroughly investigated. These can include brain tumours, aneurysm, meningitis and other systemic illnesses.

Your physiotherapist or doctor may recommend that you complete a headache or migraine questionnaire that will assist in your headache classification, diagnosis and treatment. Once you complete these questionnaires please present the results to your physiotherapist or doctor to assist your diagnosis and treatment.

Headaches or Migraine Questionnaire

At PhysioWorks, we have a special interest in the assessment, diagnosis and treatment of neck headache, tension type headache, stress headache and jaw headache.

For more information, please ask your physiotherapist.

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Headache RED FLAGS!

If suffer any of the following symptoms, please notify your physiotherapist or doctor as soon as possible.

All Red Flags MUST be thoroughly investigated!

We urge you to check with your doctor or physiotherapist to investigate further if your headaches have any of the following characteristics:

  • Sudden or severe headache - “thunderclap” type headache.
  • New or "different" headache to your normal type.
  • Your “worst headache ever”!
  • Signs of neurological complications e.g. motor weakness, memory loss, confusion, behaviour changes, reduced alertness or meningismus (stiff neck + photophobia + headache).
  • New headache onset over the age of 40 to 50 years.
  • Headaches at night or waking in the morning.
  • Headache associated with systemic symptoms e.g. weight loss, fever, nausea or vomiting.
  • Onset of headache after cough or sneeze, exercise, coitus or head turning.
  • New onset of a headache during or following pregnancy.
  • A previous history of cancer.

If you have any of the above Red Flags symptoms, we strongly recommend that you inform your physiotherapist and seek the advice of your doctor or an emergency department immediately.

Can an Unsupportive Pillow Cause Tension Type Headaches?

neck headache

Yes. Unfortunately, a non-supportive pillow or one not suited to your neck can predispose you to neck pain or tension type headache.

If you suffer neck pain or headache, it is wise to ask for the professional advice of your physiotherapist regarding what pillow style and size they would recommend for you.

Pillows do vary and the best one for your neck shape and body size will help you prevent neck pain and neck headache.

More info: Best Pillows

Headaches and Migraine Questionnaires

Discover what is causing your Headache or Migraine...

Common Headache Treatments

  • Early Injury Treatment
  • Avoid the HARM Factors
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Scapular Stabilisation Exercises
  • Closed Kinetic Chain Exercises
  • Biomechanical Analysis
  • Proprioception & Balance Exercises
  • Medications?
  • Ergonomics
  • Posture Correction
  • Soft Tissue Massage
  • Brace or Support
  • Deep Neck Stabilisation Exercises
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for Headaches & Migraine


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  • Headache - Migraine

    Common Causes

    General Information

    Specific Migraine - Headache Types

    Migraine - Headache Questionnaires

    Neck Conditions

    Jaw Conditions

    Systemic Conditions

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    Last updated 11-Oct-2019 03:52 PM

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