Headache,  Migraine

Cluster headache – Hortons headache

Cluster Headache (sometimes also called Horton’s headache) is an extremely painful form of headache. The disease is characterized by periods of very painful headache attacks, which are usually located to one eye. The pain is extremely intense, and many people compare the pain to kidney stones or childbirth. The pain can radiate downwards, outwards or upwards in the side of the joint, and can also be felt in the back of the head and down to the neck. The number of attacks per day is usually 1-2 (max 8) and preferably occurs at night.

Cluster headache is a periodic illness, which usually recurs with daily, hour-long attacks during periods of trouble of a few weeks up to a few months, usually once a year.
In about 10%, there is a chronic form with daily attacks for one to several years. Cluster headache rises quickly to a maximum, and after 15 minutes to 3 hours – usually 30-60 minutes – it drops back just as quickly.

About 90% of those affected have the episodic variant with accumulated headache attacks, so-called clusters, for periods of a few weeks to a few months. The periods occur about once or twice a year, usually during the fall and spring, and in between, you have no problems. A period begins with a slow escalation of more and more headache attacks. When the period reaches its maximum, the attacks will occur at least once a day, before they are eroded and finally cease completely. In a few cases, only a single period occurs throughout the lifespan.

The disease picture and severity are similar between the individuals and are so characteristic that it is clearly distinguishable from other headache types.

A rare condition

Cluster Headache or Hortons Headache is a rare condition. It’s estimated that about 0.1% of the population (1 in 1,000 people) suffer from Cluster Headache. Compared to other types of headaches and migraines, men suffer to a greater extent than women, about 70% of patients are men. The disease debuts when you are between 20-40 years. The debut can happen earlier, but it is unusual for children and young people to have a Cluster Headache. In most people, headaches cease at age 65, but they also occur higher up in age. Unlike migraine, nausea and vomiting are not a typical symptom, but it does exist in some and almost exclusively in women. Sound and light sensitivity is also not characteristic but can occur and is due to having both migraine and Hortons.


In recent years it has been found that Cluster Headache is hereditary to some extent. About 5% of those affected have Cluster Headache in the family. It has also been seen that many with Cluster Headache have migraine in the family. About 15% have both diagnosed Cluster headache and migraine.


A number of those who have Cluster headaches are smokers or have been exposed to indirect smoking during their upbringing. However, there is no evidence that headaches cease if you stop smoking.


Cluster headache is characterized by an extremely painful and intense pain like:

  • Sitting in, behind, or around one eye.
  • Feels like the eye is squeezed from behind, or a knife is twisted in the eye.
  • The headache is cutting, drilling, chopping, penetrating, and a pulsating feeling.
  • It radiates toward the temple, down to the upper jaw and into the teeth.
  • Its s one-sided and sits on either the right or left side of the head.
  • The pain makes it difficult to stay still and aggravated by lying down.
  • The headache gives rise to restlessness and a willingness to move. Usually, the patient wanders around restlessly during the attack, or sits and rocks with his head between his hands.

At the same time as the pain, one or more of the following symptoms occur from the eye and/or nose of the joint:

  • Lacrimation
  • Red-eye white
  • Nasal congestion
  • Small pupil combined with drooping eyelids (partial to fully developed Horner’s syndrome)


The exact cause of cluster headaches is unknown, but cluster headache patterns suggest that abnormalities in the body’s biological clock (hypothalamus) play a role. Theories of central hypothalamic genes with both hormonal and circulatory disorders. Unlike migraine and tension headache, cluster headache generally isn’t associated with the triggers, such as foods, hormonal changes, or stress. But the attacks are sometimes triggered by nitroglycerin and alcohol.

Horton’s headache is a neurovascular and primary form of headache, which means it is not caused by any underlying disease or injury. What gives rise to Hortons is not exactly known, but it is probably a combination of anomalies in the nerves that control the blood vessels in the eye, the meninges, and the face. It has been seen that some blood vessels in the eye and brain expand and swell sharply during a headache attack, and this probably contributes to the pain.


The hypothalamus is activated

Research has shown that part of the hypothalamus, an area deep in the brain, is active and enlarged at the Hortons. The hypothalamus controls our biological clock, and that could explain Horton’s regular pattern. The parts of the brain that affect heart rhythm and blood pressure are also activated, as are several of the body’s neurotransmitters such as histamine and serotonin.

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