Troy patients are seen at the Headache Express clinic in St. Louis, Missouri. Strictly one-sided attacks around the eye, lasting fifteen minutes to three hours and often at the same hour, point to cluster headache, which is treated with high-flow oxygen and a sphenopalatine ganglion block.
From Troy the run is I-55/70 to I-270 and west toward the airport, ending at Woodson Road — roughly forty minutes outside peak. It is the longest of our Illinois drives, so the visit is built around getting an answer rather than a trial of something else.
The headache that gets the wrong name for years
One pattern is worth describing precisely, because people carry it for a long time under the wrong label. Attacks that arrive at the same time of day or night, last between fifteen minutes and three hours, and are strictly one-sided around or behind the eye — often with a watering eye, a blocked nostril or a drooping lid on that side.
That is not migraine, and the distinction is not academic: the treatments that work for one are largely not the ones that work for the other. Migraine or cluster headache sets the two side by side, and the diagnostic delay covers why it takes so long to name.
Restlessness is the tell
A useful discriminator is what you do during an attack. Migraine drives people to a dark, still room; cluster does the opposite — pacing, rocking, unable to stay put. Reported plainly, that single detail moves the diagnosis further than most of the questions that get asked.
The other is the clock. Attacks that cluster into a period of weeks and then remit, or that wake someone at a consistent hour, are describing a pattern with a name.
What actually treats it
Acute treatment is the part most often got wrong. High-flow oxygen through a non-rebreather mask aborts attacks for many people and is neither a drug nor a sedative — but it fails routinely for mechanical reasons that are entirely fixable. Why oxygen fails is worth reading before concluding it does not work for you, alongside the evidence behind it.
Where a procedural option is appropriate, the sphenopalatine ganglion block targets the pathway these attacks travel. Oxygen therapy covers setup and supply.
The sphenopalatine block, specifically
The sphenopalatine ganglion sits behind the nose and carries much of the autonomic traffic that produces the watering eye, the blocked nostril and the drooping lid on the affected side. Interrupting it targets the pathway these attacks actually travel rather than the pain in the abstract.
It is a short procedure without sedation, and you drive yourself home. The block explained covers what it does and does not do, and the procedure page covers how it is performed here.
Where the presentation is less clear-cut, a stellate ganglion block is sometimes the more appropriate target. Which one applies is a diagnostic question, not a preference.
When a headache warrants imaging
Cluster and migraine are both diagnosed clinically, not on a scan, and a normal MRI does not make either less real. But there is a defined set of circumstances where imaging is genuinely indicated, and knowing the list stops both unnecessary scans and dangerous reassurance.
New pattern after fifty, a headache that changes character, neurological signs that persist between attacks, or a first attack that is the worst of someone’s life — those get imaged. A twenty-year history of stereotyped one-sided attacks with a normal examination generally does not.
When a headache needs a scan covers the indications, and the red flags cover the narrower set that should not wait for an appointment at all.
Getting oxygen actually set up
High-flow oxygen is one of the few acute treatments for cluster headache with good evidence and no systemic drug effect, and the commonest reason it fails is logistical rather than physiological: the wrong mask, an inadequate flow rate, a cylinder that runs out, or a supplier who has never filled this indication before.
It needs a non-rebreather mask rather than a nasal cannula, a high flow rate, and enough supply to treat several attacks a day during a bout. The evidence and how it is arranged here cover the detail.
Preventing the bout, not just the attack
Cluster runs in bouts, and the aim during one is to shorten it rather than to abort attacks indefinitely. That means a preventive started early in the bout, a bridge while it takes effect, and a plan agreed before the next bout begins rather than improvised when it does.
People who have had this for years usually know their season better than any clinician does, and that knowledge is worth building the plan around. Cluster headache treatment covers the sequence.
Keeping a record through a bout
Time of onset, duration, side, and what was used and whether it worked. Through a bout that is a lot of entries, and it is worth it, because bout patterns are individual and the plan for the next one is built from the last one.
The single most useful field is time of onset. Attacks that arrive at a consistent hour open up preventive timing that is not available to someone whose record says only that it was a bad week.
Closer in, headache treatment for Maryville explains how hospital-based care is coordinated through Anderson Hospital.
Common questions
How is this told apart from migraine?
By duration, side, timing and behavior during an attack — cluster is shorter, strictly one-sided, often nocturnal, and people pace rather than lie still. The comparison in full.
My oxygen did not help. Does that rule it out?
Not on its own. Flow rate, mask type and how early it is started all decide whether it works, and each is a common failure point: why oxygen fails.
Is the drive worth it for a diagnosis?
That is the honest question with a forty-minute trip. A visit that establishes which headache you actually have changes every decision afterward, which a repeat prescription does not: cluster headache treatment.
When should a headache be scanned?
When the pattern is new, abruptly different, or carries specific warning features — not routinely. When a headache needs a scan.