Cluster Headache Symptoms and Treatments

Cluster headaches are a rare and painful type of primary headache disorder.

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 returning.

Man sitting on couch with headache
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Symptoms of Cluster Headaches

Cluster headaches have a characteristic timing, severity, type, and location of symptoms.

  • When you have a cluster headache you'll feel severe pain that's often described as sharp or burning.
  • The pain occurs on one side of the face, above the eye, and around the temple on the same side of your face.
  • The pain will usually peak in the first five to 10 minutes and can last up to two hours before subsiding. It can wake you up in the middle of the night.
  • You may also experience other symptoms associated with cluster headaches, including swelling around one or both eyes, tearing or reddening of eyes, nasal congestion, pale skin, and restlessness.

Your healthcare provider may detect Horner syndrome, a condition in which the pupil of the affected eye is smaller than normal, and the eyelid is drooping. Along with the symptoms, this sign will resolve as soon as the headache dissipates.

How Are Cluster Headaches Treated?

Pain medications—even narcotics—usually don't work well with cluster headaches.

Cluster headache treatment involves methods for treating a headache while it's happening, as well as preventative methods.

Acute Treatment

Inhaled oxygen is the first line therapy for cluster headache treatment, meaning it's the treatment of choice. Research has shown that inhaling oxygen can slow or stop a cluster headache attack.

Your healthcare provider also may recommend medications called triptans to stop a cluster headache. Imitrex is a common triptan. You can inject triptan medications, take them by mouth, or take them nasally.

Injectable dihydroergotamine is also sometimes used. Be aware that dihydroergotamine is dangerous if used combined with triptans.

Sometimes triptans or injectable dihydroergotamine are prescribed with inhaled oxygen.

Preventatives

If your cluster attacks are not frequent, you might not be prescribed a preventative medication to take all the time. Preventives are usually started at the time that a cluster attack starts. Learn about triggers of cluster headaches so you may help prevent them.

These include verapamil, nerve blocks, Topamax, or Emgality, a cGRP inhibitor, A short course of steroids may help shorten the cluster episode.

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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.

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

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.

  • Silberstein SD et al. "An Atlas of Headache." Parthenon Publishing.

  • Silberstein SD et al. "Wolff's Headache and Other Head Pain," seventh edition. Oxford University Press.

  • U.S. National Library of Medicine. Cluster Headache fact sheet.

  • U.S. National Library of Medicine. Horner Syndrome fact sheet.

  • Young, WB et al. "Migraine and Other Headaches." Ney York: AAN Press.

  • 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.