Cluster Headaches
Cluster headaches cause severe, one-sided pain around the eye or temple. Attacks begin quickly and may occur several times a day during an active cluster period. Tearing, eye redness, nasal symptoms and restlessness often occur on the painful side.
Cluster headache is a neurological condition that needs medical assessment and treatment. It differs from common tension-type headaches, migraine and headaches caused by the neck or jaw.
Quick answer
Cluster headache attacks usually last 15 minutes to three hours. A GP, neurologist or headache specialist should assess suspected cluster headaches and guide treatment.
What Are Cluster Headaches?
Cluster headache is a primary neurological headache disorder. It belongs to a group called trigeminal autonomic cephalalgias. These conditions cause one-sided head pain with automatic facial responses, such as tearing or a blocked nose.
The attacks occur in active periods known as cluster periods. A person may have repeated attacks for several weeks or months, followed by a period without symptoms.
The pain usually centres around one eye, above the eye or at the temple. It may spread into the forehead, cheek, jaw or upper teeth. People often describe it as piercing, burning or unbearable.
What Does a Cluster Headache Feel Like?
A cluster headache usually causes severe or very severe pain on one side of the head. The pain builds quickly and often makes it difficult to sit or lie still.
Unlike many people with migraine, who may prefer to rest in a quiet room, someone having a cluster headache attack may pace, rock or feel intensely restless.
What Other Symptoms Can Occur?
Cluster headaches may cause one or more of these symptoms on the same side as the pain:
- red or watery eye
- blocked or runny nose
- eyelid swelling
- facial or forehead sweating
- drooping eyelid
- a smaller pupil
- facial flushing
- restlessness or agitation
Not everyone develops every symptom. However, the combination of severe one-sided eye or temple pain and same-side facial symptoms provides an important diagnostic clue.
How Long Do Cluster Headaches Last?
An untreated cluster headache attack usually lasts from 15 minutes to three hours. During an active cluster period, attacks may occur from once every second day to as often as eight times a day.
Attacks often follow a recognisable daily pattern. Some people wake with an attack at a similar time each night. However, the timing and frequency vary between people.
Are There Different Types of Cluster Headache?
Doctors classify cluster headache according to the pattern of active and symptom-free periods.
Episodic Cluster Headache
Episodic cluster headache involves active periods followed by remission lasting at least three months. An untreated active period may last from seven days to one year.
Chronic Cluster Headache
Chronic cluster headache continues for at least one year without remission, or with remission periods lasting less than three months.
Why Do Cluster Headaches Occur?
The exact cause remains unclear. Research suggests that the hypothalamus may play a role. This part of the brain helps regulate sleep, hormones and the body’s internal clock.
Cluster headache also involves the trigeminal nerve, which carries sensation from the face, and the autonomic nervous system, which controls responses such as tearing, sweating and nasal congestion.
The condition is not caused by poor posture, muscle tightness or a neck joint problem. However, a person can have cluster headache and a separate musculoskeletal headache at the same time.
What Can Trigger a Cluster Headache?
During an active cluster period, alcohol can trigger an attack in some people. Strong odours, disrupted sleep and changes in sleep patterns may also coincide with attacks.
The same exposure may have no effect outside an active cluster period. Therefore, triggers vary and do not explain the underlying condition.
A headache diary can help record:
- the time each attack begins
- how long the attack lasts
- the location and severity of pain
- eye, nose or facial symptoms
- possible triggers
- medicines used and their effect
How Are Cluster Headaches Diagnosed?
A GP, neurologist or headache specialist usually makes the diagnosis. There is no single test that confirms cluster headache.
The clinician will consider:
- the location and severity of pain
- how quickly each attack develops
- how long the attacks last
- how often they occur
- same-side eye, nose or facial symptoms
- whether the person becomes restless during an attack
- the pattern of active periods and remission
MRI, CT or other tests may be recommended when symptoms are unusual, the examination raises concern or another cause needs to be excluded.
Several conditions can produce one-sided head or facial pain. These include migraine, sinus or eye disorders, other trigeminal autonomic headaches and some secondary headache conditions. A careful medical assessment helps separate these problems.
How Are Cluster Headaches Treated?
Cluster headache needs medical treatment because attacks become severe quickly. Common oral pain medicines are often too slow to provide useful relief during a short attack.
A doctor or neurologist may prescribe treatment to stop an attack and reduce future attacks. Depending on the person’s diagnosis and medical history, management may include:
- high-flow medical oxygen through a suitable non-rebreather mask
- a rapid-acting triptan medicine for acute attacks
- preventive medicine, commonly verapamil
- short-term transitional treatment while preventive medicine takes effect
- other specialist treatment when first-line options are unsuitable or ineffective
These treatments require medical guidance. Oxygen equipment, medicine selection, dosing and monitoring must suit the individual’s health history.
Does Physiotherapy Treat Cluster Headaches?
Physiotherapy does not treat the neurological cause of cluster headaches and does not replace medical care.
However, some people also have a separate neck, jaw or musculoskeletal problem. For example, a person may experience cluster headache alongside a cervicogenic headache, TMJ-related headache or neck stiffness.
A physiotherapist can assess these separate symptoms. Treatment may be appropriate when the examination identifies a relevant joint, muscle, movement or jaw problem. It should not be presented as treatment for the cluster headache itself.
Are Cluster Headaches Dangerous?
Cluster headaches cause extreme pain but are not usually life-threatening. However, a severe headache should not be assumed to be a cluster headache without assessment, particularly when it is new, sudden or different from previous attacks.
Seek urgent medical care
Call 000 or attend an emergency department for a sudden explosive headache, collapse, confusion, seizure, new weakness, difficulty speaking, loss of vision, fever with neck stiffness or a severe headache after significant head trauma.
Read more about severe headache warning signs.
When Should You See a Doctor?
Arrange prompt medical assessment when:
- you experience severe one-sided headache attacks for the first time
- the attacks repeatedly occur around one eye or temple
- the painful eye becomes red or watery
- you develop same-side nasal or eyelid symptoms
- headaches wake you at a similar time each night
- your usual headache pattern changes
- your current treatment no longer controls the attacks
A clear diagnosis matters because treatments for cluster headache differ from treatments for migraine, tension-type headache and neck-related headache.
What Should You Do Next?
If your symptoms match a cluster headache pattern, arrange an assessment with your GP. Your GP may begin treatment or refer you to a neurologist or headache specialist.
Keep a record of attack times, duration, symptoms and possible triggers. Bring this information and a list of medicines to your appointment.
Physiotherapy may be appropriate when you also have separate neck, jaw or movement-related symptoms. A physiotherapist can assess whether a musculoskeletal condition is present and advise whether physiotherapy has a useful role.
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Cluster Headache FAQs
What are cluster headaches?
Cluster headaches are a neurological headache disorder that causes severe one-sided pain around the eye or temple. Attacks occur in active periods and often include tearing, eye redness or nasal symptoms on the painful side.
How long does a cluster headache attack last?
An untreated cluster headache attack usually lasts between 15 minutes and three hours. Attacks may occur several times a day during an active cluster period.
What can trigger a cluster headache?
Alcohol can trigger attacks in some people during an active cluster period. Sleep disruption and certain strong odours may also trigger attacks, although individual patterns vary.
Can physiotherapy treat cluster headaches?
Physiotherapy does not treat the neurological cause of cluster headaches. It may help a separate neck, jaw or musculoskeletal condition when a clinical assessment identifies one.
Who should diagnose cluster headaches?
A GP, neurologist or headache specialist should assess suspected cluster headaches. Diagnosis depends on the attack pattern, associated symptoms and exclusion of other causes.
Are cluster headaches a type of migraine?
No. Cluster headache and migraine are separate neurological headache disorders. They differ in attack duration, behaviour during an attack, associated symptoms and treatment.
Can cluster headaches affect sleep?
Yes. Attacks can occur during sleep and may wake a person at a similar time each night. Their timing may reflect the involvement of the body’s internal biological clock.
Related Articles
References
- Headache Classification Committee of the International Headache Society. Cluster headache. International Classification of Headache Disorders, 3rd edition. View diagnostic criteria.
- May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ. Cluster headache. Nature Reviews Disease Primers. 2018;4:18006. View study.
- Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of cluster headache: the American Headache Society evidence-based guidelines. Headache. 2016;56(7):1093–1106. View guideline.
- Schindler EAD, Wright DA, Weil MJ, et al. Recent advances in the diagnosis and management of cluster headache. BMJ. 2022;376:e059577. View review.
- May A, Evers S, Goadsby PJ, et al. European Academy of Neurology guidelines on the treatment of cluster headache. European Journal of Neurology. 2023;30(10):2955–2979. View guideline.
- Rodriguez-Leyva I, et al. Cluster headache: state of the art in treatment. Frontiers in Pain Research. 2023. View review.
- Petersen AS, Lund N, Goadsby PJ, et al. Recent advances in diagnosing, managing and understanding the pathophysiology of cluster headache. The Lancet Neurology. 2024;23(7):712–724. View review.
