Cluster Headache Symptoms and Treatments

Cluster headaches may be the most painful type of headache you can have — and if you've ever had them, you know that's true.

Most commonly, you'll awaken in the middle of the night with severe pain on one side of your face, centered over your eye. The pain will peak in the first five to 10 minutes and can last up to two hours before subsiding.

They're called "cluster headaches" because these headaches come in clusters lasting for weeks or even months. You can have a series of cluster headaches, and they then can go into remission for months or years before possibly returning. Cluster headache fortunately is a rare form of headache disorder.

Man sitting on couch with headache
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Symptoms of Cluster Headaches

As I said above, when you have a cluster headache you'll feel severe pain on one side of your face, above your eye and around the temple on that side of your face. You might describe the pain as sharp or burning.

You may also experience other symptoms associated with cluster headaches, according to the Mayo Clinic, reporting swelling around one or both eyes, tearing or reddening of eyes, nasal congestion, pale skin, and restlessness.

If you see your healthcare provider during an attack, she may find you have a rare condition called Horner syndrome — the pupil of your affected eye may be smaller than normal, and your eyelid may be drooping. These symptoms will resolve as soon as the headache dissipates.

It's Not Clear What Causes These Headaches

Healthcare providers aren't certain why some people experience cluster headaches. It's possible that problems in the part of your brain called the hypothalamus play some role, and the headaches may be related to abrupt releases of the neurotransmitters serotonin or histamine.

There are some factors that place you at a higher risk for experiencing cluster headaches, though. More men than women have cluster headaches, for example.

Potential cluster headache triggers include both factors you can control, plus some you cannot. Some triggers that cause cluster headaches are controllable. The Will Erwin Headache Foundation reports several factors, including drinking alcohol, heat, high altitude, bright lights, weather changes, and nitroglycerin.

Treating Cluster Headaches Can Be Difficult

Even though cluster headaches are pretty rare, healthcare providers have identified several ways to treat them.

Inhaled oxygen is the so-called "first line therapy" for cluster headaches, meaning it's the treatment of choice. Research has shown that inhaling oxygen can slow or stop a cluster headache attack. However, a 2011 study found that many practitioners are reluctant to prescribe oxygen, making it difficult to obtain for cluster headache sufferers. It's also an expensive treatment option.

Healthcare providers also may recommend medications called triptans — Imitrex is a common triptan — to stop a cluster headache. You can inject triptan medications or take them nasally. Sometimes triptans are prescribed with inhaled oxygen. Other medications used for cluster headaches include short-term steroids and injectable dihydroergotamine. Be aware that dihydroergotamine is dangerous if used combined with certain triptans.

Pain medications -- even narcotics -- usually don't work well with cluster headaches. As a last resort, your doctor may recommend surgery to help alleviate your pain.

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3 Sources
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  1. May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang S-J. Cluster headache. Nat Rev Dis Primers. 2018;4(1):18006. doi. 10.1038/nrdp.2018.6. Published March 2018.

  2. Martin TJ. Horner syndrome: a clinical review. ACS Chem Neurosci. 2018;9(2):177-186. doi. 10.1021/acschemneuro.7b00405. Published December, 2017.

  3. Schulte LH, Haji AA, May A. Phase dependent hypothalamic activation following trigeminal input in cluster headache. Journal of Headache Pain. 2020;21(1):30. doi.10.1186/s10194-020-01098-2. Published March, 2020.

Additional Reading
  • "The International Classification of Headache Disorders, 2nd Edition." Cephalalgia 24 (s1). doi: 10.1111/j. 1468-2982.2003.00824.x
  • Evans RW et al. "Handbook of Headache, Second Edition." Philadelphia: Lipincott Williams & Wilkins. 2005.
  • Law S. et al. Triptans for acute cluster headache. The Cochrane Database of Systematic Reviews. 2013 Jul 17;7:CD008042.
  • Obermann M. et al. Pharmacotherapy options for cluster headache. Expert Opinion on Pharmacotherapy. 2015 Jun;16(8):1177-84.
  • Rozen TD et al. Inhaled oxygen and cluster headache sufferers in the United States: use, efficacy and economics: results from the United States Cluster Headache Survey. Headache. 2011 Feb;51(2):191-200.
  • Silberstein  SD et al. "An Atlas of Headache." Parthenon Publishing, 2002.
  • Silberstein SD et al. "Wolff's Headache and Other Head Pain," seventh edition. Oxford University Press, 2001.
  • U.S. National Library of Medicine. Cluster Headache fact sheet. Accessed Nov. 29, 2015.
  • U.S. National Library of Medicine. Horner Syndrome fact sheet. Accessed Nov. 29, 2015.
  • Young, WB et al. "Migraine and Other Headaches." Ney York: AAN Press. 2004.