Cluster headache

Overview

A cluster headache is a very painful type of headache that happens in groups or 'clusters' over weeks or months, then goes away for a long time. The pain is usually on one side of the head, around the eye or temple, and is often described as a burning or piercing sensation. It is one of the most painful types of headache, but it is not dangerous.

Cluster headaches are relatively rare compared to other types of headaches. About 1 in 1,000 people experience them.

Cluster headaches can affect anyone, but they are more common in men, usually starting between the ages of 20 and 40. They can also occur in children and older adults, though less often.

Symptoms

Common symptoms

• Severe, sharp pain on one side of the head, often around the eye or temple
• Pain that feels like a burning, piercing, or throbbing sensation
• Pain that reaches its peak within 5 to 10 minutes
• Restlessness or agitation during an attack (pacing, rocking)
• Redness or watering of the eye on the affected side
• A droopy eyelid or pupil that is smaller on the painful side
• Runny or stuffy nose on the affected side
• Sweating on the forehead or face on the affected side
• Attacks can last from 15 minutes to 3 hours, and may occur several times a day

Symptoms in children

• Children may have the same symptoms, but might not be able to describe the pain clearly. They may cry, hold their head, or be very restless.
• Eye redness, runny nose, or sweating on one side of the face can also occur in children.

Symptoms in older adults

• In older adults, cluster headaches may be less common, but symptoms are similar. The pain can be severe and may be mistaken for other conditions like trigeminal neuralgia (nerve pain in the face).
• Older adults may also have other health issues that affect treatment choices.

Causes

Main causes

• The exact cause is not fully understood, but it is thought to involve changes in the brain's hypothalamus (a part of the brain that controls body rhythms like sleep and temperature).
• Cluster headaches are not caused by high blood pressure, stress, or eye strain.

Risk factors

• Being male (more common in men)
• Age between 20 and 40
• Smoking or a history of smoking
• Family history of cluster headaches
• Alcohol consumption can trigger an attack during a cluster period

When to see a doctor

See a doctor urgently if:

• If you have a sudden, severe headache that is unlike any you have had before
• If your headache is accompanied by a stiff neck, fever, confusion, or weakness on one side of the body
• If you have a headache after a head injury

Book a routine appointment if:

• If you experience recurrent, severe headaches on one side of your head, especially around the eye
• If you have headaches that happen in clusters (several times a day for weeks) and then disappear

Diagnosis

Diagnosis is based on your medical history, a description of your symptoms, and a physical examination. Your doctor will ask about the pattern, location, and timing of your headaches.

Tests that may be done

• No specific test for cluster headaches, but your doctor may order imaging studies such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan to rule out other causes.

What to expect at your appointment

Your doctor will likely ask you to keep a headache diary to record when attacks happen, how long they last, and what symptoms you have. This helps confirm the diagnosis and plan treatment.

Treatment

Treatment aims to stop an attack quickly and prevent future attacks. Your doctor will work with you to find the best approach. There are medicines that can be used at the start of an attack, and preventive treatments taken daily to reduce the number and severity of attacks.

Self-care at home

• Keep a regular sleep routine and avoid skipping meals
• During a cluster period, avoid alcohol and strong smells (like paint or perfume)
• Use a cool compress on the painful area during an attack
• Try to stay calm and rest in a quiet, dark room

Medical treatments

Treatments include inhaled oxygen therapy, which can help abort an attack, and prescription medicines that can be taken as injections or nasal sprays at the start of an attack. Preventive treatments may include daily oral medications or nerve blocks (injections near certain nerves) to reduce the frequency of attacks. Always follow your doctor's advice and never share medications.

When is surgery considered?

Surgery is rarely needed and is only considered if other treatments do not work. Procedures may target specific nerves to reduce pain, but they have risks and are not a cure.

Living with this condition

Living with cluster headaches can be challenging because attacks can come on suddenly and interfere with work, sleep, and daily life. Keeping a headache diary can help you identify triggers and patterns.

Lifestyle tips

• Maintain a consistent sleep schedule, even on weekends
• Avoid alcohol during cluster periods
• Manage stress through relaxation techniques like deep breathing
• Avoid activities that trigger attacks, such as intense physical exertion

Diet and exercise

There is no specific diet for cluster headaches, but eating regular meals and staying hydrated can help. Gentle exercise, like walking, may be fine between attacks, but avoid heavy exercise during a cluster period as it might trigger an attack.

Mental health and emotional wellbeing

The severe pain can cause anxiety, fear, and depression. It is normal to feel worried, especially if attacks disrupt your life. Talk to your doctor or a mental health professional if you feel overwhelmed. Support groups can also help you connect with others who understand.

Prevention

You cannot fully prevent cluster headaches, but you can take steps to reduce the number and severity of attacks. Avoiding triggers during a cluster period and taking preventive medications as prescribed can help.

Complications

If left untreated

• Untreated cluster headaches can cause severe disability during attacks, affecting work, school, and relationships
• Chronic lack of sleep due to attacks at night can lead to fatigue and irritability
• Pain may lead to anxiety or depression

Long-term outlook

With the right treatment and support, most people with cluster headaches can manage their symptoms and improve their quality of life. Attacks often become less frequent with age. It is important to work with your doctor to find a treatment plan that works for you.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.