Cluster Headaches

Overview

Cluster headaches are a type of primary headache, meaning a headache that is not caused by another illness. They cause severe pain on one side of the head, often around the eye or temple. The attacks come in clusters — for example, every day for weeks or months — and then may go away for a long time. During an attack, many people feel restless and cannot sit still.

Cluster headaches are uncommon. They are much less common than migraine, and many doctors see only a few cases. Because of this, diagnosis can sometimes be delayed.

Cluster headaches most often start between the ages of 20 and 40. They are more common in men than in women, but anyone can get them, including children. A family history can sometimes play a part.

Symptoms

Common symptoms

• Severe pain on one side of the head, usually around the eye, above the eye, or at the temple.
• The pain builds quickly and can be extremely intense.
• A red, watery eye on the same side as the pain.
• A drooping or swollen eyelid on the same side.
• A blocked or runny nose, or sweating on the forehead, on the same side.
• Restlessness or agitation — many people pace, rock, or cannot keep still during an attack.
• Attacks often happen at the same time each day or night, and may wake you from sleep.
• Between attacks, you may feel completely normal.

Symptoms in children

• Cluster headaches are rare in children.
• When they do happen, attacks may be shorter or less typical than in adults.
• Children may seem very restless, irritable, or unable to settle during an attack.
• Any new severe or repeating headache in a child should be checked by a doctor.

Symptoms in older adults

• Starting to have cluster headaches after age 50 is uncommon.
• New headaches in older adults need careful review, because other causes are more likely.
• Tell your doctor about any new weakness, confusion, fever, weight loss, jaw pain when chewing, or vision changes.

Causes

Main causes

• The exact cause is not fully understood. Cluster headache involves the trigeminal nerve, a major nerve that carries feeling from the face, and a part of the brain called the hypothalamus, which helps control body rhythms. This may explain why attacks often happen at the same time each day or night.
• It is not caused by a brain tumour or by stress alone. It is a recognised medical condition.

Risk factors

• Being male — cluster headache is more common in men, though women can have it too.
• Age — most people start having attacks between 20 and 40 years old.
• Family history — some people with cluster headache have a relative with the same condition.
• Smoking — smoking is linked with cluster headache, especially the long-lasting form.
• Alcohol — drinking alcohol can trigger an attack during a cluster period, but usually not between cycles.
• Changes in sleep, strong smells, weather changes, and high altitude may trigger attacks in some people.

When to see a doctor

See a doctor urgently if:

• You have a first-ever severe one-sided headache around the eye or temple.
• Your headache pattern changes, or headaches become much more frequent or severe.
• You have any emergency warning signs, such as a sudden worst-ever headache, fever with stiff neck, confusion, seizure, weakness, trouble speaking, or vision loss — call your local emergency number immediately.
• You are pregnant or have recently given birth and have a severe or unusual headache.
• You have a new headache after age 50.
• You have severe eye redness or swelling.

Book a routine appointment if:

• You think you may have cluster headaches and want a diagnosis.
• Your attacks are not well controlled, or your treatment is not working.
• You are having side effects from treatment.
• Headaches are affecting your sleep, work, school, or mood.
• You want advice on triggers and self-care.

Diagnosis

There is no single test for cluster headache. A doctor usually diagnoses it by listening carefully to your symptoms and history — especially the pattern, timing, length, and location of attacks. They will also check for warning signs that could point to another cause. A headache diary can be very helpful.

Tests that may be done

• A neurological examination — a check of your nerves, strength, sensation, coordination, and vision.
• A headache diary recording when attacks happen, how long they last, and what they feel like.
• An MRI or CT scan of the brain if your symptoms are unusual or if there are warning signs.
• An eye examination if eye symptoms are prominent.
• Blood tests only if the doctor suspects another condition.

What to expect at your appointment

You may be referred to a neurologist or a headache clinic. Diagnosis is usually based on your symptom pattern rather than a scan. It can take time to get the right diagnosis, so keeping notes about your attacks is useful. Ask your doctor to explain what they are checking for and what the next steps are.

Treatment

Treatment for cluster headache has two main aims: stopping an attack quickly when it starts, and preventing future attacks during a cluster period. Treatment is tailored to you. Some attack treatments work best when started as soon as the attack begins, so have a clear plan from your doctor.

Self-care at home

• Keep a headache diary to spot patterns and triggers.
• Avoid alcohol during a cluster period.
• Try to keep regular sleep and wake times.
• Avoid known triggers such as strong smells or sudden weather changes where possible.
• Follow your agreed treatment plan and keep any prescribed attack treatment with you.
• Do not drive or operate machinery if an attack starts, because the pain and restlessness can make it unsafe.
• Ask your pharmacist or doctor before using over-the-counter painkillers regularly — frequent use can cause more headaches.

Medical treatments

For an attack, doctors may prescribe high-flow oxygen through a mask, or prescription medicines given by injection or nasal spray. Ordinary over-the-counter painkillers usually do not work well for cluster headache. For prevention, doctors may prescribe daily medicines to reduce how often attacks happen, or a short course of treatment to help break a cluster cycle. Specialist treatments can include nerve blocks or nerve stimulation devices. Your doctor will explain the options, benefits, and risks for you.

When is surgery considered?

Surgery is rarely used for cluster headache. In very severe cases that do not respond to other treatments, specialist teams may consider nerve stimulation or other procedures. This is not standard first-line treatment and would only be offered after careful assessment.

Living with this condition

Cluster headache can be unpredictable and exhausting. Planning ahead helps: tell family, friends, and colleagues what to do if an attack starts, keep your treatment plan handy, and rest when you can. A diary can help you and your doctor see whether treatment is working.

Lifestyle tips

• Keep regular sleep and wake times, including weekends where possible.
• Avoid alcohol during cluster periods.
• Notice and limit triggers such as strong perfumes, fumes, or sudden temperature changes.
• Stay active in gentle ways, but avoid overexertion if it triggers attacks.
• Eat regular meals and stay hydrated.
• Manage stress where possible, though stress is not the cause of cluster headache.

Diet and exercise

There is no special diet for cluster headache. Some people find alcohol triggers attacks during a cluster period, so avoiding it then is sensible. Regular gentle exercise and a steady daily routine may help overall wellbeing. If exercise seems to trigger attacks, talk to your doctor about how to adjust your activity.

Mental health and emotional wellbeing

Cluster headache can be frightening and can affect sleep, work, relationships, and mood. Anxiety and low mood are common when pain is severe and unpredictable. Tell your doctor if you feel overwhelmed. If you ever have thoughts of harming yourself, seek emergency help or contact a local crisis service straight away.

Prevention

Cluster headache cannot always be prevented, but preventive treatment and trigger management can reduce how often attacks happen. Avoiding alcohol during a cluster period, keeping regular sleep, and following your treatment plan can all help. Work with your doctor to find the best approach for you.

Vaccines

There is no vaccine for cluster headaches.

Screening programmes

There is no routine screening test for cluster headache. See a doctor if you have new, severe, or changing headaches.

Complications

If left untreated

• Very severe pain and exhaustion.
• Poor sleep and daytime tiredness.
• Missed work, school, or social activities.
• Anxiety, low mood, or feeling isolated.
• Medication overuse headache if painkillers are used too often.
• Less effective treatment if diagnosis is delayed.

Long-term outlook

Cluster headache can be hard to live with, but it is treatable. Many people find a plan that reduces attacks or helps them cope better. Some people have cluster periods for weeks or months and then long pain-free stretches. Others have a long-lasting form that needs specialist care. With the right support, most people can get better control and a better quality of life.

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