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Cluster headache is the most severe form of headache known to humans and is sometimes referred to as "suicide headache". It earned its name from the pattern of attacks. Patients generally have daily attacks for weeks at a time (clustered together) and then enter into periods of remission when they have no headaches. Cluster headache has also been called the "alarm clock headache" due to the regular periodicity of the attacks. Several terms related to cluster headache are important to define, including:

• An individual cluster headache is also called a cluster attack.
• A cluster period, cycle or episode is defined as the time in which cluster patients are having daily headaches.
• A remission period is the time in which cluster patients are experiencing no headaches.

Cluster headache is divided into 2 types, episodic and chronic. Most patients have episodic cluster headache (90%) while only a small number suffer with chronic cluster headache.

Episodic Cluster Headaches

Episodic cluster headache consists of "active" or "on" periods that may last for days to months (typically 6-12 weeks) during which headaches may occur every other day or as frequently as 8 times per day. Individual attacks typically last between 15 minutes and 3 hours. Headache-free remissions commence spontaneously and may last from a number of months to several years.

Chronic Cluster Headaches

Chronic cluster headache is characterized by the absence of remission for 1 year or short remissions that last less than 28 days. Patients with chronic cluster headache experience unremitting headaches for years, which is a source of severe debilitation and significant reduction in quality of life. Approximately 10% of all cluster headache patients have chronic cluster headache. In 90% of the cases of chronic cluster headache, the person first experienced episodic cluster headaches which, over time, failed to achieve remission. This condition is known as secondary chronic cluster headache. This may occur under the following circumstances:

• Onset of cluster headache later in life
• Frequent episodic cluster headache with very brief periods of remission
• Heavy smoker
• High alcohol intake
• Head trauma

Approximately 10% of individuals with chronic cluster headache suffer from primary chronic cluster headache which is characterized by their never experiencing a remission from the onset of the first cluster headache. Some people who suffer from chronic cluster headache develop episodic cluster headache before the end of attacks in later life.

Medication is effective for approximately 80% of individuals suffering from chronic cluster headache but up to 20% of patients do not respond to medication. Over time, some individuals who were helped by a particular drug for years may become resistant to that drug.

There is continuing debate regarding whether people who suffer from cluster headache have a 'typical' appearance. Some claim that there is a "leonine" appearance to many people who suffer from cluster headache and distinct facial characteristics, (e.g., deep vertical facial creases, ruddy complexion) but it is not clear whether these features may be due to heavy tobacco or alcohol use rather than cluster headache specifically. Some researchers have noted that individuals suffering from cluster headache tend to be the tallest members of their families, though this has not been proven.