Cluster headaches – NHS

Cluster headaches are excruciating attacks of pain in one side of the head, often felt around the eye.

Cluster headaches are rare. Anyone can get them, but they’re more common in men and tend to start when a person is in their 30s or 40s.

Symptoms of a cluster headache

Cluster headaches begin quickly and without warning. The pain is very severe and is often described as a sharp, burning or piercing sensation on one side of the head.

It’s often felt around the eye, temple and sometimes face. It tends to affect the same side for each attack.

People often feel restless and agitated during an attack because the pain is so intense, and they may react by rocking, pacing or banging their head against the wall.

You may also get 1 or more of the following symptoms:

• a red and watering eye
• drooping and swelling of 1 eyelid
• a smaller pupil in 1 eye
• a sweaty face
• a blocked or runny nostril

The attacks generally last between 15 minutes and 3 hours, and typically occur between 1 and 8 times a day.

What causes cluster headaches?

The exact cause of cluster headaches is not clear, but they have been linked to activity in part of the brain called the hypothalamus.

People who smoke seem to have a higher risk of getting cluster headaches.

Some people who get cluster headaches have other family members who also get them, which suggests there may be a genetic link.

Cluster headache attacks can sometimes be triggered by drinking alcohol or by strong smells, such as perfume, paint or petrol.

Pattern of attacks

Cluster headaches usually happen every day, in bouts lasting several weeks or months at a time (typically 4 to 12 weeks), before they subside.

A symptom-free period (remission) will often follow, which sometimes lasts months or years before the headaches start again.

People tend to get cluster headaches at the same time each day. For example, they often wake up with a headache within a couple of hours of going to sleep.

They’ll often get cluster headaches every year for many years and they may be lifelong. They tend to happen at similar times of the year, commonly in the spring and autumn.

When to get medical advice

You should see a GP as soon as possible the first time you experience what you think may be a cluster headache.

They’ll ask you about your symptoms and may refer you for tests.

A brain scan is sometimes needed to exclude other conditions that can have similar symptoms to cluster headaches.

Typically, with cluster headaches the brain scan is normal and the diagnosis is made on the basis of your symptoms without the need for further tests.

If you’re diagnosed with cluster headaches, you’ll usually see a specialist, such as a neurologist (a specialist in brain and nerve conditions), to talk about your treatment options.

Treatments for cluster headaches

Cluster headaches are not life threatening, but they can cause severe pain and significantly affect your quality of life.

Over-the-counter painkillers, such as paracetamol, are not effective for cluster headaches because they’re too slow to take effect.

Instead, you’ll need to have one or more specialist treatments.

3 main treatments are available to relieve pain when taken soon after a cluster headache starts.

These are:

• sumatriptan injections – which you can give yourself up to twice a day
• sumatriptan or zolmitriptan nasal spray – which can be used if you do not want to have injections
• oxygen therapy – where you breathe pure oxygen through a face mask

These treatments usually relieve the pain of a cluster headache within 15 to 30 minutes.

The Organisation for the Understanding of Cluster Headache (OUCH UK) has more information about the medicines used to treat cluster headaches.

Transcutaneous vagus nerve stimulation

Transcutaneous vagus nerve stimulation (TVNS) is a fairly new treatment that uses low-voltage electrical currents to stimulate a nerve in the neck. 

The aim is to relieve pain and reduce the number of cluster headaches.

You place a small handheld device (about the size of a mobile phone) on the side of your neck. Your specialist will show you exactly where.

Gradually increase the strength of the electrical current until you can feel small muscle contractions under your skin. Hold the device in position for about 90 seconds.

TVNS can be used to treat cluster headaches when you get them, and can also be used between attacks to try to prevent them happening. But TVNS may not help everyone with cluster headaches.

For more information, read the National Institute for Health and Care Excellence (NICE) guidance about transcutaneous vagus nerve stimulation.

There’s also a new portable TVNS device called gammaCore. NICE has said that gammaCore can be effective for some people and reduce the need for medicines.

Stimulation device implantation

If you’ve had cluster headaches for a long time and other treatments have not worked, surgery to implant a stimulation device may be recommended.

Under general anaesthetic, a small electrical device is implanted in a cavity in the side of your face.

It emits electrical currents that stimulate an area of the parasympathetic nervous system thought to be associated with cluster headaches.

When you get a headache, you activate the device (up to a pre-determined maximum dose) by placing a handheld unit on your cheek over the place where the implanted device is located.

As with TVNS, the aim of treatment is to relieve pain and reduce the frequency of cluster headache attacks.

NICE has recommended that the treatment is safe for short-term use (up to 2 months) under close specialist supervision.

For more information, read the NICE guidance about implantation of a sphenopalatine ganglion stimulation device for chronic cluster headache.

Preventing cluster headaches

Avoiding triggers

Avoiding the triggers of cluster headaches can help prevent them.

For example, you should not drink alcohol during a cluster headache bout.

You should also try to avoid strong-smelling chemicals, such as perfume, paint or petrol, which can often trigger an attack.

Becoming overheated during exercise can also bring on a cluster headache attack in some people, so it’s best not to exercise during a bout.

Smoking has also been linked to an increased risk of getting cluster headaches, so you should consider giving up smoking (if you smoke).

Medicines

Your doctor may prescribe medicine to prevent cluster headaches during a bout.

You start taking the treatment as soon as the headaches begin, and continue it until the bout is thought to have stopped.

A medicine called verapamil is the main treatment for preventing cluster headaches. It’s taken as a tablet several times a day.

Verapamil can cause heart problems in some people, so while taking it you’ll need to be monitored using a test called an electrocardiogram (ECG).

Other treatments may be considered if verapamil is not effective. These may include corticosteroids, lithium medicine and local anaesthetic injections into the back of the head (occipital nerve blocks).

Preventative treatments can vary in effectiveness from person to person.

You may need to try a few different treatments before your attacks are brought under control.

Help and support

Living with cluster headaches can be very difficult, particularly if you have long-term (chronic) cluster headaches.

You may find it useful to get further information, advice and support from organisations such as OUCH (UK).

OUCH (UK) has an answerphone messaging service you can call. The number is 01646 651 979.

You can also contact them by email: [email protected].

Page last reviewed: 01 May 2020
Next review due: 01 May 2023

Headache Behind Eye: Causes, Triggers, and Treatment

Written by Mary Jo DiLonardo, John Donovan

Medically Reviewed by Jennifer Robinson, MD on December 13, 2022

• What Is a Headache Behind the Eye?
• Causes of Headache Behind the Eye
• Headache Behind the Eye Triggers
• Headache Behind the Eye Treatment
• Waking Up With a Headache Behind the Eyes?

If you feel pain behind your eyes, there are many possible causes. There’s a good chance it could be a specific type of headache.

Migraine headaches

These headaches often begin with pain around your eye and temple. They can spread to the back of your head. You might also have an aura, which can include visual signs like a halo or flashing lights that sometimes come before the pain starts.

Getting a headache behind your eyes can happen for a wide range of reasons, including migraine and sleep problems.

You may also have nausea, a runny nose, or congestion. You could be sensitive to light, sounds, or smells. Migraine headaches can last several hours to a few days.

Tension headaches

These are the most common type of headache. They usually cause a dull pain on both sides of your head or across the front of your head, behind your eyes. Your shoulders and neck may also hurt. Tension headaches might last 20 minutes to a few hours.

Cluster headaches

These cause severe pain around your eyes, often around just one eye. They usually come in groups. You may have several of them every day for weeks and then not have any for a year or more before they start again.

Along with the pain, you may also have watery eyes, congestion, and a red, flushed face. The attacks last 30 to 60 minutes and are so strong that you may be restless and can’t stand still while they happen. Cluster headaches aren’t very common and mostly happen in men.

Sinus headaches

A sinus infection (sinusitis) can cause a headache around your eyes, nose, forehead, cheeks, and upper teeth. This is where your sinuses are. You’ll often also have a fever, congestion, and a thick nasal discharge. The pain usually gets worse throughout the day.

True sinus headaches are rare. Migraine and cluster headaches are often mistaken for sinus headaches.

Eyestrain

This is when your eyes get tired from working too hard from doing things like staring at a computer screen or driving for a long time.

Other symptoms can include:

• Sore, itching, burning eyes
• Watery eyes
• Blurred vision
• Sore shoulders or back

Eyestrain isn’t serious and usually goes away when you rest your eyes.

Different things may set off each type of headache.

You might get migraines because of:

• A lack of sleep
• Weather changes
• Stress
• Lights
• Noises
• Smells
• Things you eat or drink, like alcohol, chocolate, or MSG
• Missing a meal

Things that may give you a tension headache include:

• Stress
• Eyestrain
• Poor posture
• Problems with the muscles or joints in your neck or jaw
• Fatigue
• Dehydration or missing a meal
• Bright sunlight
• Noise
• Certain smells

Cluster headaches are often triggered by alcohol, smoking, or certain medications.

Learning to avoid your triggers may prevent headaches or make them less painful. If you do get one, there are many kinds of treatments.

Medication for headache behind the eye

Over-the-counter pain medicine can ease occasional headaches. It may even help with migraine if you take it early enough. Doctors often recommend acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. But remember that taking them too often can trigger overuse headaches.

If you get frequent tension headaches, your doctor may prescribe medication. Antidepressants like amitriptyline help many people.

Sometimes, prescription drugs are the only things that will ease migraine pain. Some of the most common are triptans such as almotriptan (Axert), eletriptan (Relpax), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). They help most people within 2 hours if taken early enough. People who get chronic migraines often take medicine like beta-blockers or antidepressants every day to help cut back on how many they have.

Breathing pure oxygen may bring relief of cluster headaches. Injected triptans like sumatriptan and lidocaine nose drops might also help. Some people take medicines such as verapamil (Calan, Verelan) or prednisone to prevent attacks.

Treat a sinus headache by clearing up the infection. Your doctor might suggest antibiotics and decongestants.

Home remedies for headache behind the eye

Caffeine or ice packs may help with migraine pain.

For a tension headache, try a heating pad or a warm shower, or rest until the headache goes away. It can also help to find better ways to handle stress. Learn relaxation techniques like yoga or deep breathing. Try not to skip meals or get too tired.

When you have a sinus infection, breathe in warm, moist air from a vaporizer or a pot of boiling water to ease congestion. Warm compresses can also help.

If your eyes are often strained, take breaks and blink more. Artificial tears may also refresh your eyes. Check with your doctor to make sure your vision prescription is up to date, and ask about exercises to strengthen eye muscles.

If you wake up in the morning with a pounding headache behind your eyes, you’re not alone. Here’s a look at some common causes of morning headaches:

Hangovers. After drinking too much alcohol, when your blood alcohol content drops back to normal or close to it, you start to feel symptoms that can include headaches. They can be caused by a couple of things. When you drink, the alcohol causes your body to make more urine, which can cause you to become dehydrated. The alcohol also causes your blood vessels to expand, which can lead to headaches. If you have more severe symptoms like confusion, seizures, slow breathing, or loss of consciousness, get medical help right away.

Migraine. The most common time for a migraine to happen is the early morning as pain medication you took before you went to sleep begins to wear off. But migraine headaches are complicated. They’re different for everybody. If you have a migraine or headache of any type that continually wakes you in the morning and gets in the way of your work or personal life, a doctor’s visit may be in order. Treatments, including over-the-counter and prescription medications, are available.

Sleep apnea. This is a condition where your throat muscles partially collapse while you sleep and interrupt your breathing. Other signs of sleep apnea include dry mouth and snoring. Sleep apnea is a serious health problem. Your doctor may suggest that you do a sleep test. A continuous positive airway pressure (CPAP) machine might help, and lifestyle changes like losing weight and rolling off your back while you sleep could also help you get better rest.

Other sleep disorders. The relationship between sleep and headaches is a tricky one. Sometimes headaches are the cause of poor sleep, sometimes they’re the result of it. If it’s hard to get to sleep, stay asleep, or if you just wake up too early, you may have insomnia. It’s been tied to some forms of chronic headaches, including morning headaches. Circadian rhythm sleep disorders mess with when you fall to sleep or wake up. They can lead to morning headaches, too. If you think you may have a sleep disorder, see your doctor.

Overmedication. A medication overuse headache (MOH) can happen if you’re already prone to headaches and you take a lot of pain meds. A MOH usually hits right when you wake up. For those with chronic headaches, using medication more than 2 or 3 days a week may be too much. Check with your doctor about this. They can help you treat your headaches without overusing pain meds.

TMJ. The temporomandibular joint (TMJ) connects your jaw to your skull. Pain in the joint and its surrounding muscles, caused by things like too much gum chewing or clenching and grinding your teeth at night, can bring a morning headache. A dentist can prescribe an oral device to keep you from grinding your teeth at night. 

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Headache and pressure on eyes. Causes of pain that presses on the eyes.

Headache and pressure on eyes. Causes of pain that presses on the eyes.

Gimranov Rinat Fazylzhanovich
Neurologist, neurophysiologist, experience – 33 years;
Professor of Neurology, MD;
Clinic for Rehabilitation Neurology. About the author

Publication date: June 26, 2021

Updated: October 24, 2022

Headache is a common phenomenon that periodically visits healthy people. The negative influence of external factors, banal fatigue and / or a number of diseases can lead to the fact that a person’s well-being will deteriorate sharply.

If there is a headache around the eyes, an increase in eye pressure is felt and such sensations become habitual, then it is worth contacting the doctors for a complete diagnosis[1].

Special attention should be paid to cases when taking painkillers does not help to get rid of discomfort. Especially when the pathology is accompanied by accompanying symptoms, indicating a third-party disease.

Article content:

• 1 Causes
  • 1.1 Provoking factors
  • 1.2 When you need a doctor
• 2 Signs of dangerous conditions
• 3 Diagnosis
• 4 Treatment
• 5 Prevention
• 6 References 900 27

Causes

Headache is a non-specific symptom that indicates dozens of different diseases .

Including those that, at first glance, do not relate to problems with the head.

One should be attentive to one’s condition and, if unpleasant sensations arise, analyze whether this is due to external factors.

Provoking factors

Severe headache that presses on the eyes is caused by various reasons:

1. Labile emotional state. Impressive people, experiencing strong emotions, often begin to feel bad. As a rule, this is manifested by localized head cephalgia and an increase in blood pressure, causing an unpleasant feeling in the eye area. A similar picture is typical for VVD of the hypertonic type.

1. Lowering blood glucose levels. This problem concerns not only people with diabetes, but also healthy people. Hunger has a negative effect on well-being. To get rid of discomfort, you need to eat and see if the pain syndrome goes away.

1. Bad habits. The use of substances that gradually destroy the body leads to similar consequences.

1. Inadequate and insufficient sleep, regular severe violation of the regime of rest and work, sleep.

1. Increased intracranial pressure. A dangerous condition that causes severe headache and a feeling of pressure behind the eyes. With head movements, tilt, discomfort will intensify.

1. Wrong choice of devices to improve vision[2]. Glasses and lenses should be selected by a doctor for each person after passing the diagnosis. You may not take into account the specific features of your own vision and provoke a deterioration in the condition. You can avoid discomfort if you turn to an ophthalmologist.

1. Tumors and cysts, which have a specific location in the frontal lobes of the brain, can lead to the fact that a person will regularly feel unwell. If the pain persists and painkillers do not help, you should immediately consult a doctor.

1. Infectious diseases. Intoxication of the body in acute infections is often manifested by such unpleasant symptoms. Soon the rest of the spectrum of symptoms develops – fever, weakness, muscle pain.

1. Concussion. Traumatic brain injuries are dangerous because their consequences are extremely difficult to predict.

1. Physical and psycho-emotional overwork. The manifestation of symptoms is typical for people who devote too much time to intellectual work that requires constant eye strain. Reading, working at a computer, constant access to gadgets are fraught with complications – this is what leads to “dry eye syndrome” [3].

When a doctor is needed

Due to such variability of causes, it can be difficult to understand the situation.

If something regularly presses strongly on the left or right eye from the inside and the head hurts, eye pressure rises, then even the doctor will not immediately tell what kind of disease it is.

A comprehensive examination using instrumental techniques will help to understand the diagnosis.

Pathological processes developing in the organ itself can cause discomfort in the eye area. This situation is dangerous, as it can lead to blindness. You should not postpone a preventive visit to the doctor if the discomfort has become frequent or increases in intensity.

You can read more about the detailed symptoms of a headache.

Signs of dangerous conditions

As a rule, a slight indisposition in the form of a headache around the eyes and a feeling of pressure is eliminated by taking painkillers or even using a folk prescription.

However, there are situations when you need to urgently seek medical help, since the symptoms that appear indicate the development of a serious pathology:

1. Unpleasant sensations regularly return, their intensity increases.
2. Taking painkillers, massage, rest do not help, the pain does not go away.
3. The condition arose suddenly, against the background of well-being or physical, psycho-emotional overload.

1. In addition, the temperature rises, other signs of the development of an infectious disease can be traced.
2. The head hurts very much, with time the sensations become only more acute.
3. Nausea and vomiting are additional symptoms.

Severe headache in the region of the eyes and orbits, felt inside the skull, can have dangerous causes, the symptoms are characteristic of a number of serious diseases [4].

Dangerous diseases occur with similar symptoms: meningitis, strokes, tumor processes. In this case, immediate medical attention can save a life.

Diagnosis

If you experience frequent severe headaches and a feeling that something is pressing on your eyes, you need to immediately find out the causes of the unpleasant condition.

To do this, contact your GP for a basic diagnosis. Based on the results of the initial examination and further tests, the doctor will be able to determine what caused the painful sensation and refer you to a specialized doctor.

To make an accurate diagnosis, find out:

• the nature and strength of the pain that occurs;
• place of concentration of unpleasant sensations;
• duration and frequency of seizures.

After the initial examination, the doctor will refer the patient to a number of studies necessary to clarify the diagnosis:

• electroencephalography (EEG), which will show the electrical state of the brain;
• laboratory blood tests for inflammation, hormonal disruptions, tumor markers;
• Ultrasound or x-ray for suspected intracranial pathology;
• MRI to exclude tumors, search for signs of different variants of encephalopathies.

Based on the results of the examination, a therapeutic course is drawn up, adapted to a particular patient.

Treatment

Pressure on the eyes from the inside, headache are symptoms of many diseases, so self-medication in this case is extremely dangerous.

If this condition occurs only once, then it is possible to take an anesthetic, before carefully studying the instructions [5].

If the head hurts a lot in the area of ​​the eyes or in the area of ​​the eye sockets for about a week, then the doctor must first determine the causes. And then – to prescribe a therapy corresponding to the identified pathology.

Depending on the detected disease, it is possible to use several methods of treatment:

• Drug component. The selection of drugs makes it possible not only to quickly get rid of discomfort, but also to cure the root cause. At the same time, it is extremely important to complete the course of prescribed medications to the end in order to consolidate the result.

• Physiotherapy is prescribed if indicated. With certain diseases, they give a noticeable positive effect: they improve blood circulation in the brain, relieve pain. As a rule, the following are used: acupressure, electrophoresis, laser therapy, balneological (water) procedures.

• Some patients may require surgery.

After the doctor prescribes the treatment, you should not add various folk remedies to it without prior approval. In combination with already prescribed medications and procedures, they can have a negative effect, harm.

Prevention

The ailments in question are possible for every person, but this does not mean that one should not try to avoid them. As a rule, a headache around the eyes or near them can be prevented by applying a set of preventive measures.

Most diseases that lead to the development of such symptoms are the result of an unhealthy lifestyle. By applying simple rules and slightly rearranging your daily life, you will significantly improve your well-being and prolong youth without diseases.

Current events:

• Reduce the amount of harmful substances in life. Avoiding drugs, alcohol and nicotine-containing mixtures will positively affect the entire body.
• Reducing the time spent at the computer, with the phone in hand and with other gadgets. The influence of a bright screen, even taking into account modern technologies, has an extremely negative effect on eye health.
• Decreased consumption of fast food and the transition to a healthy diet rich in vitamins. No bias towards fatty and fried foods.

• Control the amount of sweets in the daily diet.
• Regular traffic. Even with sedentary work, you need to devote 20-30 minutes to walking every day. During the working day, take breaks for a short warm-up, relieving unnecessary stress.
• Physiotherapy exercises 3-5 times a week will noticeably improve physical condition and immunity.

If, despite following all the recommendations, headaches and pressure in the eyes bother you regularly, you need to contact a specialist[4]. Only timely diagnosis will ensure quick and correct treatment and subsequent relief from the problem without complications.

References

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“Pressing pain” inside the eye: possible causes

Pressing pain in the eyes is a complaint that worries some of our patients. Attributing such sensations to general fatigue and overload, many of them do not seek help from an ophthalmologist and do not even realize that eye pain can be the first symptom of the development of a dangerous disease.

Possible causes of pressing pain in the eyes

The cause of pressing pain in the eyes can be not only eye diseases, but also pathologies of other organs and body systems. First of all, these are diseases of the central nervous system, ENT pathologies and others.

Among the most common causes of pressing pain in the eyes are:

Optic neuritis – inflammation of the optic nerve, accompanied by decreased visual acuity, blurred vision, pain in the eyes, headache, change in color perception, changes in the field of vision.

Glaucoma is an ophthalmic disease usually accompanied by an increase in intraocular pressure. This condition provokes the development of degenerative and atrophic changes in the optic nerve, which progress and lead to a gradual decrease in vision, and sometimes even its complete loss. Some forms of glaucoma may also be accompanied by symptoms such as pressing pain inside the eye, a sharp decrease in visual acuity, fog before the eyes.

Migraine – a neurological disease characterized by the appearance of recurrent headaches or pain in the eyes, lasting from 4 to 72 hours without a break. The pain is usually throbbing in nature and is accompanied by additional symptoms: nausea, vomiting, increased sensitivity to light and sounds.

Cluster headaches is a bodily condition characterized by numerous and frequent attacks of headache. Such pain occurs abruptly and lasts from 30 minutes to 3 hours. The pain can radiate (give) to various parts of the face, including the eyes. In addition, cluster pain may be accompanied by redness of the eyes, the appearance of lacrimation and swelling around the eyes.

Sinus infections can also cause headaches that radiate to the eye area. Usually the cause of pain is an inflammatory process in the nasal sinus (maxillary, frontal). Treatment is carried out by an otolaryngologist and includes the appointment of drugs to eliminate the cause of inflammation, as well as decongestants.