Last updated:03-03-2009
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Definition and causes

Hortons headache also named Cluster Headache is a rare condition that affects around 1 out of 1,000 adults. The cause of the disease is not known, but it affects predominantly men, and the first symptoms typically occur in persons around 20-40 years of age. There is a slight tendency to inheritance and heavy smokers are hit by this form of headache with greater frequency. 
Hortons headache is a neglected disease and many patients suffer for years before a diagnosis is made. The disease is very painful and for some people it is directly debilitating. Hortons headache comes in sudden attacks and the attacks are formed as clusters, hence the name cluster headaches. A cluster is a time frame that lasts weeks or months (usually one to three months), with daily attacks. Between cluster attacks the patient can be symptom free for half a year or even several years. A few patients (about 15% of all cases) have no such symptom free periods but rather a chronic condition where, on the other side, the daily attacks are fewer. 
During an attack period there might be between one and eight attacks per day. The individual attacks last from half to four hours, usually about one hour at a time. Attacks occur mostly at night and alcohol can be a contributory factor. 


Symptoms of Hortons headache 

  • Intense pain around and behind one eye (always the same eye) 
  • The pain can be spread  to the jaw, ears or the rest of the head 
  • The pain can be unbearable 
  • The eye is watery, turns red with possible swelling and closed. The eye lid hangs 
  • Nose runs and feels clogged 


As the pain is so intense, it is important to properly diagnose the disease as the condition can be treated and also because knowledge about the disease and the knowledge that it is not dangerous, reassure patients. The diagnosis is based on the medical history of the attacks.

Treatment of Hortons headache

The treatment of an attack consists of migraine medication and oxygen mask. However, this should always be combined with preventive treatment. There are a number of drugs to choose from, inter alia, blood pressure medicines, adrenal cortical hormones and lithium.


The disease is normally prolonged, but the symptoms often diminish over the years and in some disappear altogether. 

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