Cluster Headaches: Symptoms, Triggers and the Treatments That Actually Help

Cluster headaches are often described as one of the most painful conditions a person can experience. The attacks are short, brutal and come in clusters that can last weeks. They’re often misdiagnosed for years. Getting the right diagnosis matters, because the treatments that work are very different from those for ordinary headaches.

Imagine waking at 2am, every night for three weeks, with a stabbing pain behind your right eye so intense you can’t lie still. You pace the room, rocking, pressing your head. Your eye streams and turns red, your nose runs on the same side. After 45 minutes it stops as suddenly as it started. Then tomorrow night, at almost exactly the same time, it happens again.

Symptoms of cluster headache

• Severe, sharp or burning pain on one side, around or behind the eye, temple or forehead
• Attacks lasting about 15 minutes to 3 hours
• Up to several attacks a day, often at the same times, especially at night
• On the same side: a red, watering eye, drooping or swollen eyelid, smaller pupil, and a blocked or runny nostril
• Restlessness and agitation: people pace or rock rather than lie still, unlike migraine
• Cluster periods lasting weeks to months, followed by pain-free periods

Who gets it, and common triggers

Cluster headache is more common in men and often starts between the ages of 20 and 40. Many people with it smoke or used to. During a cluster period, attacks can be triggered by alcohol, strong smells such as paint or petrol, and getting too hot.

Treatments that help

• High-flow oxygen through a special mask, prescribed for use at home, can stop an attack within minutes for many people.
• Triptan injections or nasal sprays work fast. Tablets are usually too slow.
• Preventive medicines, such as verapamil, taken during cluster periods to reduce attacks. These need monitoring, including heart checks.
• Short-term treatments such as steroids or nerve blocks may be used to break a cluster.

Everyday painkillers such as paracetamol, ibuprofen and codeine usually don’t work, because they act too slowly.

But when is a severe headache an emergency?

Call your emergency number for a sudden “thunderclap” headache that reaches full intensity within a minute, a headache with weakness, slurred speech, confusion, a stiff neck and fever, or a headache after a head injury. If you think you have cluster headaches, see a doctor, who may refer you to a neurologist or headache clinic. Living with cluster headache can be very hard on mental health, so ask for support.

Sources: NHS (Cluster headaches), NICE guideline on headaches in over 12s, US National Institute of Neurological Disorders and Stroke, World Health Organization (Headache disorders). This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.