Cluster Headaches

Cluster Headaches

Article by John Miller

What are Cluster Headaches?

Cluster Headache

Cluster Headache sufferers tend to report their pain as 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 have a distinct pattern of occurrence.

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 GP 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, you are more likely to suffer from another problem or migraine source.

You may also be suffering from a mixed or multi-source headache.

Your physiotherapist will advise you if you have symptoms that could indicate a different cause for your headache. These instances 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 headache + tension headache, + migraine!

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 with your diagnosis and headache source. Sometimes specific tests can confirm your diagnosis. On other occasions, it can be by process of elimination.

In a small percentage of patients, unfortunately, a sinister cause of your head pain requires investigation. These can include brain tumours, aneurysms, 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 your physiotherapist or doctor’s results to help with your diagnosis and treatment.

FAQs about Headaches & Migraines

Article by John Miller

What is a Primary and Secondary Headache?

The International Headache Society classifies headaches as Primary or Secondary.

Primary headaches are not related to any other problem and include migrainestension-type headaches and cluster headaches.

Secondary headaches. Caused by an underlying problem and can include a post-whiplash headacheneck headache, jaw headache and drug withdrawal headache. “Ice cream headache” is a secondary headache caused by extreme cold within your mouth. In other words, a secondary headache is a symptom of something else being wrong rather than the cause itself. Treatment for a secondary headache involves treating the source, e.g. loosen some stiff upper neck joints or stop eating ice cream!

Multi-Source Headache


It is also important to point out that many headache sufferers may suffer multi-source headaches. For example, a migraine sufferer may simultaneously experience a tension-type headache and neck headache. Treatment will vary depending upon your specific symptoms and headache source.

Please consult with your healthcare practitioner for an accurate diagnosis and treatment pathway.

More info: Headaches & Migraines

Article by John Miller

When Should You Be Concerned about a Headache?


Unfortunately, in a small percentage of patients, there is a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.

You MUST thoroughly investigate any Red Flags!

headache red flags

Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:

  • History your worst ever headache or a different headache to your usual.
  • Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
  • Age is higher than 50 years.
  • Despite treatment, your headache persists.
  • Acute onset.
  • Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
  • HIV or another immune system compromise
  • fEver or other systemic symptoms, e.g. weight loss, rash.

If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.

Less Urgent & Severe Headache Types

Fortunately, most headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis.

For specific advice, please consult your doctor or headache physiotherapist.


Article by John Miller

Suffering a Headache or Migraine?

If you are suffering from a headache or migraine, it is appropriate that your first step is to consult your doctor. Your doctor will examine you and then determine if a neurological opinion is required and whether a CT or MRI scan of your head is necessary. In the vast majority of cases, your scans will be reasonable. Occasionally, scans can identify significant but luckily uncommon headache sources such as an aneurysm or tumour.

If Your Scan is Normal?

Firstly, you should feel relieved. Scans will rule out the more sinister causes of headaches or migraines.

Discovering Your Headache Source?

headache treatmednt

We recommend that you should then commence a process of elimination, starting with the most commonly diagnosed and easily fixed sources.

Two familiar sources of headache that can undertake an assessment and elimination are neck headache and jaw headache.

Researchers believe that at least one in four headaches are neck origin. A thorough examination of your neck by a skilled headache physiotherapist is your next port of call. You'll have over a 25% chance that your physiotherapist will confirm and then relieve your headache at your first consultation.