Headaches: Cluster - Risk Factors

Risk Factors

Cluster headaches are rare, affecting less than 1% of the population.

Age and Gender

Cluster headaches can affect all ages, from children to the elderly, but are most common from young adulthood through middle age. Men are 2 - 3 times more likely to have cluster headaches than women, with the peak age of onset occurring during their 40s. In women, age of onset tends to be in the 60s.

Unlike with migraines, fluctuations in estrogen and other female hormones do not appear to influence the onset of attacks in women.

Lifestyle Factors

Lifestyle factors, including smoking, alcohol abuse, and stress (in particular stressful work situations), appear to play a very strong role in cluster headaches. Smoking can trigger attacks. (However, quitting smoking generally does not have an effect on the disease course.) Alcohol, most commonly red wine, may trigger an attack.

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Family History and Genetic Factors

Cluster headaches tend to run in families, suggesting a genetic component may be involved in some cases.

History of Migraine

About half of people with cluster headache have a personal or family history of migraine. Studies have reported that about 15% of patients have both kinds of headache.

Head Injury

Head injury with brain concussion appears to increase the risk of cluster headaches, although a causal relationship has not been proven.

Sleep Apnea and Other Sleep Disorders

Cluster headaches tend to occur during specific sleep stages and have been associated with several sleep disorders, including narcolepsy, insomnia, and sleep apnea.

Sleep apnea, a disorder in which a person's breathing pauses during the night, perhaps hundreds of times, is of particular interest. In some people, apnea may trigger a cluster headache during the first few hours of sleep, making patients susceptible to follow-up attacks during the following midday to afternoon periods. Treating patients who have both disorders with a device called CPAP, which opens the airways, may help improve both conditions. [For more information, see In-Depth Report #65: Sleep apnea.]