While the health information and fact sheets on this website relate to world-wide situations, the drug names will vary between countries – therefore the advice of your local GP should be sought.
|The health information and factsheets on this website are produced by Bupa's health information team. The information is reviewed and approved by relevant healthcare professionals, including doctors, dentists, nurses, physiotherapists and dietitians.||
|Browse the a-z list of factsheets:||
Published by Bupa's health information team, January 2010.
This factsheet is for people who have cluster headaches or who would like information about them.
Cluster headaches are severe headaches that affect the area behind or below the eye or the temple (the flat areas on the side of your forehead). Cluster headaches affect one side of the head only.
About cluster headaches
Cluster headaches are less common than other types of headache such as migraines and tension headaches. Around one in every 500 people get cluster headaches. Men are more likely than women to develop cluster headaches. They can happen at any age, but are most likely to start when you are in your 30s and 40s. You are more likely to get cluster headaches if you smoke.
Cluster headaches happen on one side of your head only. People who have these kinds of headaches usually also have other symptoms too, such as a drooping eyelid or red eye during the headache. Cluster headaches are extremely painful and can make you feel restless and agitated.
The headaches come and go, often in a pattern, usually happening at the same time of year and sometimes at the same time of day. Individual headaches usually last up to an hour.
Cluster headaches occur in bouts (clusters). During a bout, you're likely to get a headache at least once every two days and sometimes as often as eight times per day, although this is rare. Bouts of cluster headaches can last for weeks or months. Most people have one or two bouts every year.
Some people have remission periods, where the headaches stop for months or years. This pattern is called an episodic cluster headache. Around two in 10 people who get cluster headaches don't have remission periods. This is called a chronic cluster headache.
For more information on other types of headache, please see Related topics.
Symptoms of cluster headaches
Cluster headaches cause excruciating pain around one eye or temple, which can spread further around your head. The pain usually comes on quickly, often reaching its peak within five to 10 minutes. It remains at this intense level for the rest of the attack and then stops suddenly. Most headaches happen at night, usually an hour or two after going to sleep. The pain is severe enough to wake you and make you feel agitated and restless, as if you can't keep still. You may need to get up and pace around until the pain goes.
You may also have one or more of the following symptoms on the same side when you have a headache:
- reddened, watering eye
- runny or blocked nose
- swollen eyelid
- drooping eyelid
- small pupil
Some people continue to have a small pupil and drooping eyelid once the headache has gone.
Causes of cluster headaches
No-one knows why some people get cluster headaches and others don't. They may be caused by over-activity in a part of your brain called the hypothalamus. This part of your brain controls your body's daily rhythm, which may explain why the headaches happen at regular times.
Drinking alcohol may bring on a headache during a cluster bout, often within an hour. Other possible triggers include exercising and an increase in the temperature of your surroundings, for example hot rooms and hot baths.
Diagnosis of cluster headaches
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will refer you to see a headache specialist. This is usually a neurologist - a doctor who specialises in conditions that affect the nervous system.
A few people may be asked to have a Magnetic Resonance Imaging scan (MRI). This scan uses magnets and radiowaves to produce images of the brain.
You should see a doctor or visit a hospital if:
- you get a sudden, severe headache unlike any you have had before.
- the pain is worst upon waking
- your headache follows a head injury
You should also see a doctor if you have a headache accompanied by any of the following symptoms:
- stiff neck
- fever (high temperature) and rash
- changes to your vision
- slurred speech
- changes in your behaviour
Treatment of cluster headaches
Your GP may refer you to a neurologist or a specialist in a pain clinic for treatment. There is no cure for cluster headaches. However, there are treatments that can help to reduce the number and severity of your headaches as well as the length of each bout.
You can take medicines to help stop your headaches as soon as they start. The most effective medicine for most people is an injection of a painkiller called sumatriptan. You take sumatripan as soon as you feel a headache starting by injecting it just under your skin. It usually works within five to 10 minutes. Your doctor will show you how to give yourself the injections in your thigh or stomach. A nasal spray of sumatriptan is also available and may help some people.
Breathing pure oxygen for 10 to 20 minutes may also relieve the headache. If your doctor prescribes oxygen, you can arrange to get oxygen cylinders or an oxygen concentrator for use at home. This is usually for patients with frequent clusters.
Other types of painkillers, such as paracetamol and non-steroidal anti-inflammatory drugs like ibuprofen, don't work for cluster headaches.
If the headaches don't settle, then your doctor may treat you with a course of steroids (eg prednisolone).
Patients with chronic cluster headaches may be looked after by a neurologist who will treat them with drugs to reduce the number of clusters occurring. Examples of these drugs include verapamil, lithium or methysergide (see below).
Always ask your doctor for advice and read the patient information leaflet that comes with you medicine.
Surgery may be a treatment option for people who have tried all of the other available treatments, and who continue to have cluster headaches. Surgery is a last resort because of the risk of side-effects. Talk to your doctor for more information.
Prevention of cluster headaches
You shouldn't drink any alcohol during a bout because this can bring a headache on. Solvents and oil based paints can also bring on a headache, so keep away from these during a bout. If sleeping triggers your headaches then try not to have an afternoon nap.
There are some medicines that may prevent or reduce the number of cluster headaches. You should start taking them as early as possible during a bout of headaches as this is when they are most likely to be effective. However, there is no strong medical evidence to say which medicines work best. Your doctor will work with you to choose the medicines that are most suitable for you. You may need to take more than one medicine to treat your headaches. Speak to your neurologist for more information.
Some of the main medicines used to prevent cluster headaches are listed below.
- Verapamil. This medicine is often used as a first choice of treatment. It's usually used to treat chest pain and can affect the rhythm of your heart. You will need an electrocardiogram (ECG) before you start taking verapamill. Your doctor will arrange for you to have regular check-ups if you take this medicine.
- Corticosteroids, such as prednisolone. These can work quickly and be very effective in some people. You will only be given these medicines for a short period of time
- Ergotamine. This medicine is sometimes used for short periods of time, usually for people who have headaches that happen at the same time of day and night.
- Methysergide. This medicine is most often given to people who have long and frequent bouts of cluster headaches. It can cause serious side-effects so you should take regular breaks from it - stop taking it for one month after every six months of treatment.
- Lithium. This may be used if other medicines don't work. You will need regular blood tests if you take lithium, to make sure you are getting the right amount for it to work properly.
You will usually need to have regular check-ups with your doctor so he or she can monitor your treatments.
Cluster headaches Q&As
See our answers to common questions about cluster headaches, including:
OUCH (UK) - Organisation for the Understanding of Cluster Headache
- Guidelines for all healthcare professionals in the diagnosis and management of migraine, tension-type, cluster and medication-overuse headache. British Association for the Study of Headache, 2007. www.bash.org.uk
- What is a cluster headache? Organisation for the Understanding of Cluster Headache (OUCH) www.ouchuk.org, accessed 7 September 2009
- Headaches. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 7 September 2009
- Cluster attack. Organisation for the Understanding of Cluster Headache (OUCH) www.ouchuk.org, accessed 7 September 2009
- Causes. Organisation for the Understanding of Cluster Headache (OUCH). www.ouchuk.org, accessed 7 September 2009
- Joint Formulary Committee. British national formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:248
- Treatments. Organisation for the Understanding of Cluster Headache (OUCH). www.ouchuk.org, accessed 7 September 2009
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: January 2010