Skip to main content

Advertisement

SpringerLink
Log in

Cluster Headache: Clinical Characteristics and Opportunities to Enhance Quality of Life

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cluster headache is a highly disabling primary headache disorder characterized by severe pain and autonomic features. We present the existing body of literature on psychological factors associated with cluster headache and recommendations to address gaps in current clinical care with regards to psychological treatments for cluster headache.

Recent Findings

People with cluster headache often endorse depressive symptoms, are more likely than the general population to report suicidal ideation and behaviors, and experience significantly decreased quality of life. Psychological treatments such as Acceptance and Commitment Therapy may be particularly valuable for patients with cluster headache given that they are transdiagnostic in nature and can therefore simultaneously address the disease burden and common psychiatric comorbidities that present.

Summary

Greater understanding of the debilitating nature of cluster headache and behavioral interventions that seek to reduce the burden of the disease and improve the quality of life of people with cluster headache is paramount.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia. 2008;28(6):614–8.

    Article  CAS  PubMed  Google Scholar 

  2. Kandel SA, Mandiga P. Cluster Headache. StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.

  3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

  4. Barloese MCJ. Neurobiology and sleep disorders in cluster headache. J Headache Pain. 2015;16(1):78.

    Article  PubMed Central  Google Scholar 

  5. Brandt RB, Doesborg PGG, Haan J, Ferrari MD, Fronczek R. Pharmacotherapy for cluster headache. CNS Drugs. 2020;34(2):171–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wei DY, Goadsby PJ. Cluster headache pathophysiology - insights from current and emerging treatments. Nat Rev Neurol. 2021.

  7. O’Hare M, Cowan RP. Chapter 11 - sleep and headache. In: Miglis MG, editor. Sleep and Neurologic Disease. San Diego: Academic Press; 2017. p. 201–25.

    Chapter  Google Scholar 

  8. Burish MJ, Chen Z, Yoo SH. Emerging relevance of circadian rhythms in headaches and neuropathic pain. Acta Physiol (Oxf). 2019;225(1):e13161.

  9. Pergolizzi JV, Magnusson P, LeQuang JA, Wollmuth C, Taylor R, Breve F. Exploring the connection between sleep and cluster headache: a narrative review. Pain and Therapy. 2020;9(2):359–71.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Naber WC, Fronczek R, Haan J, Doesborg P, Colwell CS, Ferrari MD, et al. The biological clock in cluster headache: a review and hypothesis. Cephalalgia. 2019;39(14):1855–66.

    Article  PubMed  Google Scholar 

  11. • Rossi P, Little P, De La Torre ER, Palmaro A. If you want to understand what it really means to live with cluster headache, imagine... fostering empathy through European patients’ own stories of their experiences. Funct Neurol. 2018;33(1):57–9. Highlights importance of understanding patients’ with cluster headache experiences.

  12. Ji Lee M, Cho SJ, Wook Park J, Kyung Chu M, Moon HS, Chung PW, et al. Increased suicidality in patients with cluster headache. Cephalalgia. 2019;39(10):1249–56.

    Article  PubMed  Google Scholar 

  13. Palacios-Ceña D, Talavera B, López-Ruiz P, Gutiérrez-Viedma Á, Palacios-Ceña M, Arias JA, et al. Living with cluster headache: a qualitative study of patients’ perspectives. Headache. 2016;56(7):1171–82.

    Article  PubMed  Google Scholar 

  14. Abu Bakar N, Torkamani M, Tanprawate S, Lambru G, Matharu M, Jahanshahi M. The development and validation of the Cluster Headache Quality of life scale (CHQ). The Journal of Headache and Pain. 2016;17(1):79.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Farahani MA, Assari S. Relationship between pain and quality of life. In: Preedy VR, Watson RR, editors. Handbook of Disease Burdens and Quality of Life Measures. New York, NY: Springer New York; 2010. p. 3933–53.

  16. • Burish MJ, Pearson SM, Shapiro RE, Zhang W, Schor LI. Cluster headache is one of the most intensely painful human conditions: results from the International Cluster Headache Questionnaire. Headache. 2021;61(1):117–24. Highlights how cluster headache is one of the most painful diseases.

    Article  PubMed  Google Scholar 

  17. Nesbitt AD, Goadsby PJ. Cluster headache. BMJ : Br Med J. 2012;344:e2407.

  18. Kim S-K, Cho S-J, Yi JJ, Park M, Kang H-Y, Kim Y-S. Quality of life in patients with cluster headache during the active periods (P5.10–009). Neurology. 2019;92(15 Supplement):P5.10–009.

  19. •• Schenck LA, Andrasik F. Behavioral and psychological aspects of cluster headache: an overview. Neurol Sci. 2019;40(Suppl 1):3–7. (Examines behavioral and psychological aspects of cluster headache)

    Article  PubMed  Google Scholar 

  20. Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden*. Headache: The Journal of Head and Face Pain. 2012;52(1):99–113.

  21. •• D'Amico D, Raggi A, Grazzi L, Lambru G. Disability, quality of life, and socioeconomic burden of cluster headache: a critical review of current evidence and future perspectives. Headache: The Journal of Head and Face Pain. 2020;60(4):809–18. Examines impact of cluster headache on quality of life

  22. Sohn J-H, Park J-W, Lee MJ, Chung P-W, Chu MK, Chung JM, et al. Clinical factors influencing the impact of cluster headache from a prospective multicenter study. Scientific Reports. 2020;10(1):2428.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Anderson N, Ozakinci G. Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials. BMC Psychol. 2018;6(1):11.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of cluster headache: The American Headache Society Evidence-Based Guidelines. Headache. 2016;56(7):1093–106.

    Article  PubMed  Google Scholar 

  25. Donnet A, Lanteri-Minet M, Guegan-Massardier E, Mick G, Fabre N, Géraud G, et al. Chronic cluster headache: a French clinical descriptive study. Journal of neurology, neurosurgery, and psychiatry. 2007;78(12):1354–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Pohl H, Gantenbein AR, Sandor PS, Schoenen J, Andrée C. Interictal burden of cluster headache. Headache: The Journal of Head and Face Pain. 2020;60(2):360–9.

  27. Choong CK, Ford JH, Nyhuis AW, Joshi SG, Robinson RL, Aurora SK, et al. Clinical characteristics and treatment patterns among patients diagnosed with cluster headache in U.S. healthcare claims data. Headache. 2017;57(9):1359–74.

  28. Liang J-F, Chen Y-T, Fuh J-L, Li S-Y, Liu C-J, Chen T-J, et al. Cluster headache is associated with an increased risk of depression: a nationwide population-based cohort study. Cephalalgia. 2012;33(3):182–9.

    Article  CAS  PubMed  Google Scholar 

  29. Jürgens TP, Gaul C, Lindwurm A, Dresler T, Paelecke-Habermann Y, Schmidt-Wilcke T, et al. Impairment in episodic and chronic cluster headache. Cephalalgia. 2011;31(6):671–82.

    Article  PubMed  Google Scholar 

  30. Louter MA, Wilbrink LA, Haan J, van Zwet EW, van Oosterhout WP, Zitman FG, et al. Cluster headache and depression. Neurology. 2016;87(18):1899–906.

    Article  PubMed  Google Scholar 

  31. Robbins MS, Bronheim R, Lipton RB, Grosberg BM, Vollbracht S, Sheftell FD, et al. Depression and anxiety in episodic and chronic cluster headache: a pilot study. Headache. 2012;52(4):600–11.

    Article  PubMed  Google Scholar 

  32. Horton B, MacLean A, Craig WM, editors. A new syndrome of vascular headache: results of treatment with histamine: preliminary report. Mayo Clin Proc; 1939.

  33. Van Alboom E, Louis P, Van Zandijcke M, Crevits L, Vakaet A, Paemeleire K. Diagnostic and therapeutic trajectory of cluster headache patients in Flanders. Acta Neurol Belg. 2009;109(1):10–7.

    PubMed  Google Scholar 

  34. •• Schindler EAD, Cooper V, Quine DB, Fenton BT, Wright DA, Weil MJ, et al. “You will eat shoe polish if you think it would help”-familiar and lesser-known themes identified from mixed-methods analysis of a cluster headache survey. Headache. 2021;61(2):318–28. These direct accounts provide an important illustration of the clinical features and consequences of cluster headache, helping to contextualise it and its psychological and social consequences.

    Article  PubMed  Google Scholar 

  35. •• Koo BB, Bayoumi A, Albanna A, Abusuliman M, Burrone L, Sico JJ, et al. Demoralization predicts suicidality in patients with cluster headache. The Journal of Headache and Pain. 2021;22(1):28. First study to examine the role of demorilazation and suicidality in people with cluster headache.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pellegrino ABW, Davis-Martin RE, Houle TT, Turner DP, Smitherman TA. Perceived triggers of primary headache disorders: a meta-analysis. Cephalalgia. 2018;38(6):1188–98.

    Article  PubMed  Google Scholar 

  37. Rosenberg L, Butler N, Seng EK. Health behaviors in episodic migraine: why behavior change matters. Curr Pain Headache Rep. 2018;22(10):65.

    Article  PubMed  Google Scholar 

  38. Benson H, Klemchuk HP, Graham JR. The usefulness of the relaxation response in the therapy of headache. Headache. 1974;14(1):49–52.

    Article  CAS  PubMed  Google Scholar 

  39. Sargent JD, Walters ED, Green EE. Psychosomatic self-regulation of migraine headaches. Semin Psychiatry. 1973;5(4):415–28.

    CAS  PubMed  Google Scholar 

  40. Blanchard EB, Andrasik F, Jurish SE, Teders SJ. The treatment of cluster headache with relaxation and thermal biofeedback. Biofeedback Self Regul. 1982;7(2):185–91.

    Article  CAS  PubMed  Google Scholar 

  41. Blanchard EB, Andrasik F, Neff DF, Arena JG, Ahles TA, Jurish SE, et al. Biofeedback and relaxation training with three kinds of headache: treatment effects and their prediction. J Consult Clin Psychol. 1982;50(4):562–75.

    Article  CAS  PubMed  Google Scholar 

  42. Buzzi MG, Pellegrino MG, Bellantonio P. Causes and mechanisms of primary headaches: toward a bio-behavioral model. Ital J Neurol Sci. 1995;16(8 Suppl):15–9.

    Article  PubMed  Google Scholar 

  43. Driscoll MA, Kerns RD. Integrated, team-based chronic pain management: bridges from theory and research to high quality patient care. Adv Exp Med Biol. 2016;904:131–47.

    Article  CAS  PubMed  Google Scholar 

  44. Jensen R, Zeeberg P, Dehlendorff C, Olesen J. Predictors of outcome of the treatment programme in a multidisciplinary headache centre. Cephalalgia. 2010;30(10):1214–24.

    Article  PubMed  Google Scholar 

  45. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2004;35(4):639–65.

    Article  Google Scholar 

  46. Harris R. Embracing your demons: an overview of acceptance and commitment therapy: PsychOz Publications & Human Condition Bookstore; 2006. 7 p.

  47. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change, 2nd ed. New York, NY, US: Guilford Press; 2012. xiv, 402-xiv.

  48. Dindo L, Van Liew JR, Arch JJ. Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546–53.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin J Pain. 2017;33(6):552–68.

    Article  PubMed  Google Scholar 

  50. Bai Z, Luo S, Zhang L, Wu S, Chi I. Acceptance and commitment therapy (ACT) to reduce depression: a systematic review and meta-analysis. Journal of Affective Disorders. 2020;260:728–37.

    Article  PubMed  Google Scholar 

  51. Lee EB, An W, Levin ME, Twohig MP. An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug and Alcohol Dependence. 2015;155:1–7.

    Article  PubMed  Google Scholar 

  52. McCracken LM, Vowles KE. Acceptance of chronic pain. Curr Pain Headache Rep. 2006;10(2):90–4.

    Article  PubMed  Google Scholar 

  53. McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005;43(10):1335–46.

    Article  PubMed  Google Scholar 

  54. Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J Consult Clin Psychol. 2008;76(3):397–407.

    Article  PubMed  Google Scholar 

  55. McCracken LM, Gutiérrez-Martínez O. Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behav Res Ther. 2011;49(4):267–74.

    Article  PubMed  Google Scholar 

  56. • Grazzi L, Bernstein C, Raggi A, Sansone E, Grignani E, Searl M, et al. ACT for migraine: effect of acceptance and commitment therapy (ACT) for high-frequency episodic migraine without aura: preliminary data of a phase-II, multicentric, randomized, open-label study. Neurological Sciences. 2019;40(1):191–2. Examines efficacy of ACT for people with migraine.

    Article  PubMed  Google Scholar 

  57. Dindo LN, Recober A, Calarge CA, Zimmerman BM, Weinrib A, Marchman JN, et al. One-day Acceptance and Commitment Therapy compared to support for depressed migraine patients: a randomized clinical trial. Neurotherapeutics: The journal of the American Society for Experimental NeuroTherapeutics. 2020;17(2):743–53.

Download references

Funding

This work was supported by the VHA Headache Centers of Excellence and the NINDS (K23 NS096107 PI: Seng).

Author information

Authors and Affiliations

  1. Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare System, West Haven, USA

    Amy S. Grinberg, Emmanuelle A. D. Schindler, Brian B. Koo, Jason J. Sico & Elizabeth K. Seng

  2. Psychology Service, VA Connecticut Healthcare System, West Haven, USA

    Amy S. Grinberg & Kathryn M. Min

  3. Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA

    Amy S. Grinberg, Rachel D. Best & Elizabeth K. Seng

  4. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Emmanuelle A. D. Schindler, Brian B. Koo & Jason J. Sico

  5. Neurology Service, VA Connecticut Healthcare System, West Haven, USA

    Amy S. Grinberg & Brian B. Koo

  6. Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, USA

    Elizabeth K. Seng

  7. Montefiore Medical Center, Montefiore Headache Center, New York, USA

    Elizabeth K. Seng

Authors
  1. Amy S. Grinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel D. Best
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathryn M. Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanuelle A. D. Schindler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian B. Koo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason J. Sico
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabeth K. Seng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy S. Grinberg.

Ethics declarations

Conflict of Interest

Dr. Grinberg has no conflicts to report. Ms. Best has no conflicts to report. Ms. Min has no conflicts to report. Dr. Schindler has received research funding from CH-TAC, LLC, and Clusterbusters, Inc. Dr. Koo has no conflicts to report. Dr. Sico has received research funding from the Veterans Health Administration Office of Research and Development (I01HX002324 PI: Sico). Dr. Seng has consulted for GlaxoSmithKline and Click Therapeutics and received research funding from the NIH (K23 NS096107 PI: Seng).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grinberg, A.S., Best, R.D., Min, K.M. et al. Cluster Headache: Clinical Characteristics and Opportunities to Enhance Quality of Life. Curr Pain Headache Rep 25, 65 (2021). https://doi.org/10.1007/s11916-021-00979-8

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11916-021-00979-8

Keywords

Search

Navigation