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Cluster Headache

What are cluster headaches?

Cluster headaches are very painful headaches that start quickly, peak within 15 minutes, and stop suddenly. The headache usually lasts 30 to 60 minutes but can last up to 3 hours. A cluster period usually lasts for 2 to 12 weeks but can last longer than a year. Weeks or months may pass before a new cluster period begins.

What causes cluster headaches?

The cause is unknown. You are more likely to have cluster headaches if you are male. They often begin when the person is between the ages of 20 and 40 years. If you smoke or have a family history of cluster headaches, you are more likely to get them. The following can trigger cluster headaches:

  • Alcohol

  • Medicines

  • Stress

  • Bright light

  • Heat

What are the signs and symptoms of cluster headaches?

Cluster headaches follow patterns and often occur at the same time of the day or year. For example, they may occur every spring or every fall, or every night while you sleep. You may have cluster headaches once every other day, or you may have up to 8 each day. Cluster headaches sometimes happen during the day but often begin 1 or 2 hours after you fall asleep. The pain is so bad that it wakes you up. The following are signs and symptoms of cluster headaches:

Cluster headaches may involve pain around one eye, along with drooping of the lid, tearing and congestion on the same side as the pain
  • You have severe pain on one side of your head that stabs or burns. The pain occurs around or behind one eye and may spread to one whole side of your face. You may feel as if your head will explode from the pain. The pain may be so bad that you want to cry or scream.

  • Your eye is swollen, your eyelid is droopy, or tears run from your eye. Your pupil is smaller than usual, or your eye is red.

  • You have a runny or stuffy nose.

  • Your face is red, or you have sweat on your face and forehead.

  • You feel restless and want to stand or walk around.

  • You are bothered by noise or light.

  • You are very tired after the headache stops.

How are cluster headaches diagnosed?

Your caregiver will ask you to describe your symptoms. Tell him how often your headaches occur and how long they last. He will ask questions about your medical history. He will look at your face and eyes. He will ask for a list of your medications. Tell him if you smoke or drink alcohol. You may need the following tests:

  • Neurological exam: This is a series of tests to check for problems with your brain and nervous system. Your caregiver will shine a light in your eyes to find out how they react to light. He may ask questions to check your memory. He may check your hand grasp and balance.

  • CT scan or MRI: A CT scan is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. An MRI scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, called contrast, before a CT scan or an MRI to help images show up better on the monitor. Tell caregivers if you are allergic to iodine or shellfish, because you may also be allergic to the dye. Never enter the MRI room with any metal. Tell caregivers if you have any metal in your body. Metal can cause serious injury from the magnets in the MRI machine.

What medicines are used to treat cluster headaches?

There is no cure, but treatment may help your signs and symptoms. Your caregiver may have you try several medicines to find out what works best for you. You may need a blend of medicines for pain and for prevention. Ask your caregiver for more information about the medicines you need.

  • Treatment for pain relief during a cluster headache:

    • Oxygen: You may get pain relief if you breathe 100% pure oxygen during a cluster headache. You will breathe through a plastic mask that is attached to an oxygen tank for about 15 minutes. Your caregiver will give you oxygen at a clinic or you may be able to use an oxygen tank at home. Ask your caregiver for more information.

    • Migraine medicine: You need a doctor's order for medicine used to treat migraines and other headaches. These are given because they work fast to relieve your pain.

    • Steroids: These medicines help reduce pain and swelling. They may also be used to prevent cluster headaches.

    • Numbing medicine: This may be given to numb your pain if other treatments do not work.

  • Prevention medicines: One goal is to stop headaches before they happen. Another goal is to shorten a cluster period. Headaches may happen less often and be less severe with these medicines. You may take 1 medicine at the start of a cluster period. You may take a different medicine for as long as your cluster period lasts or is expected to last.

    • Seizure medicine: Medicines used to prevent seizures can also prevent cluster headaches.

    • Mood stabilizer: This medicine may prevent cluster headaches because it helps balance chemicals in your brain.

What are the risks of cluster headaches?

It can be hard to carry out normal daily activities. You may want to hurt yourself during an attack because the pain is so bad. You could develop nerve damage on your face that causes your eyelid to droop. This is called Horner syndrome. There is a risk that you could become addicted to pain medicine. The medicines used to treat cluster headaches can cause an upset stomach or a bad taste in your mouth. Your chest and throat may feel tight. The medicines can also cause you to feel more tired than usual. The medicine used to prevent cluster headaches can cause constipation or diarrhea.

How can I manage my cluster headaches?

  • Do not smoke: Cluster headaches are more common among smokers. Talk to your caregiver if you need help quitting.

  • Do not drink alcohol during a cluster period: Alcohol triggers more headaches during cluster periods.

  • Do not travel between altitudes: Altitude changes can trigger headaches. Avoid flying on an airplane or traveling between places with high and low altitudes.

  • Set a regular sleep schedule: Go to sleep and wake up at the same time each day. Changes in sleep patterns may trigger cluster headaches.

  • Manage stress: Stress, long hours at work, and emotional challenges can trigger cluster headaches. Find out what works for you to lower stress.

  • Keep a headache journal: Write down when your headaches start and stop, and exactly what you were doing when they began. Record what you ate or drank and how much you slept in the 24 hours before the headache. Keep track of the things you did to treat your symptoms. Write down if they did or did not help. Do this to learn what triggers your headaches and how to make them go away.

  • Work with your caregiver to manage your pain: Both pain relievers and medicines used to treat other health conditions can trigger cluster headaches. Go over all your medicines with your caregiver. Work with him to manage your headache pain and other conditions.

When should I contact my caregiver?

Contact your caregiver if:

  • You cannot get enough sleep because of your headaches.

  • Your headaches happen each time you are active.

  • Treatment does not help your symptoms.

  • You have questions or concerns about your treatment or condition.

When should I seek immediate help?

Seek help immediately or call 911 if you have the following symptoms during a cluster period:

  • You feel more tired or sleepy than usual.

  • You notice changes in your vision.

  • Your stomach is upset or you are vomiting.

  • You have a seizure.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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