An Overview of Cluster Headaches (2023)

Cluster headaches are characterized by sudden bouts of recurrent, severe head pain that occur every day (or nearly every day) for weeks, months, or even years. The pain associated with this condition is intense and located on one side of the head. The head pain is often accompanied by red or inflamed eyes and nasal discharge. Most people have periods of remission without attacks that last from months to years.

An Overview of Cluster Headaches (1)

This type of headache is relatively rare, affecting between 0.1 and 0.3% of the population. It is most common between ages 20 to 40 and men are twice as likely as women to experience cluster headaches.


Cluster headaches arise as severe pain in one side of the head, usually starting around one eye, before spreading to the temples and face. The intensity of this pain is described as very severe burning, poking, or piercing (as opposed to throbbing).

This may be accompanied by additional symptoms, including:

  • Flushed face and sweating
  • Redness and inflammation in the affected eye
  • Tearing
  • Drooping of the affected eyelid
  • Pupilconstriction
  • Runny or stuffed-up nose
  • Facial swelling
  • Restlessness and inability to sit still or lie down

The duration of the headache is usually 15 to 30 minutes and it can last for up to three hours. Attacks tend to group together, and you can experience one to eight periods of pain a day.

Cluster headaches tend to occur at consistent times of day—oftentimes at night—and are often seasonal, more commonly arising in the spring or fall. Cluster cycles are interspersed with periods of remission, which can last from less than a month to several years.

Why Do I Have a Headache on the Left Side of My Head?


The direct cause of a cluster headache is dilation of vessels, which puts pressure on the trigeminal nerve, a nerve associated with facial sensation and movement. Cluster headache is a primary headache disorder, which means that the reason it occurs is unknown.

Cluster headache is the most common of a group of disorders called “trigeminal autonomic cephalalgias." The autonomic nervous system, which controls involuntary activities of the body, such as pupil size, is involved in cluster headaches. Researchers have also observed altered activity in the hypothalamus, which is an area of the brain that's associated with regulating sleep-wake cycles and biological rhythm.

The Anatomy of the Trigeminal Nerve

Triggers aren’t as prevalent with cluster headaches as they are with migraines or other headache types.

(Video) Cluster Headaches

There are a number of risk factors for the condition:

  • Smoking tobacco
  • Alcohol consumption
  • Age between 20 to 40
  • Men are twice as likely as women to develop the condition
  • Family history


Proper diagnosis of this condition isn’t easy as there’s no singular test for it. What’s even more challenging is that cluster headaches can easily be mistaken for migraines. Still, diagnostic criteria are established by the International Classification of Headache Disorders.

A patient is determined to have cluster headaches if they experience at least five attacks characterized by one of the following:

  • Severe pain on one side of the head
  • Headache accompanied by at least one of the other symptoms of the condition
  • A frequency of attack of one every other day to up to eight a day

Clinical testing for cluster headache involves brain imaging or MRI, which is usually done to rule out other causes of the symptoms.


Treatment of cluster headaches is usually an individualized process, and what works for one person may not for another. If you smoke, it's important that you stop smoking, because smoking can contribute to the severity and frequency of cluster headaches.

Broadly speaking, treatments can be divided into acute treatments you can use during an attack and preventative treatments that are used to reduce the frequency and severity of attacks.

Acute treatment approaches include:

  • Oxygen: A common approach taken on in the hospital involves the delivery of pure oxygen via mask with an oxygen tank. When treated this way, dramatic reductions in symptoms are seen within 15 minutes.
  • Triptans: This pharmaceutical drug class is a common treatment for both cluster and migraine headaches. For treatment of cluster headaches, sumatriptan is can be injected by a healthcare provider or you can use it in a nasal spray form. Another type, zolmitriptan, is available as a nasal spray.
  • Octreotide: The idea behind the injection of octreotide is that it mimics the brain chemical somatostatin. While generally not as effective as triptans, this approach works very well in some cases.
  • Local Anesthetic: Local anesthetics such as lidocaine, usually delivered through the nose, can also put a stop to pain.
  • Dihydroergotamine: Another medication that’s also used in migraine treatment, dihydroergotamine, when injected, is known to be effective in relieving the symptoms of cluster headaches.

How to Get Rid of a Cluster Headache

There are also a number of preventative approaches to this condition; these are used on a regular daily basis, even when you aren't having symptoms.

Preventative treatments include:

  • Calcium Channel Blockers: These medications prevent calcium from causing contraction of the muscles in the blood vessels. They allow the blood vessels to relax, reducing blood pressure. Calcium channel blocking drugs like Calan, Verelan, and others can help prevent cluster headaches for some people.
  • Corticosteroids: This class of drug reduces inflammation and can help reduce the frequency and severity of cluster headaches for some people.
  • Lithium Carbonate: Although it's a common approach to treating bipolar disorders, lithium carbonate may be prescribed for preventing cluster headaches.
  • Nerve Block: The targeted delivery of local anesthetic combined with a corticosteroid in the area around the occipital nerve (towards the back of the head) is sometimes used to combat difficult, chronic cases of cluster headaches.
  • Emgality: In 2019, the FDA approved the injection of a migraine-preventing medication—Emgality—for cluster headache.

For chronic cluster headaches or cluster headaches that don't improve with medication, surgeries or other interventions may be considered. The stimulation of certain brain regions, for instance, can help reduce headache pain. This involves the use of electrodes called neurostimulators in either the sphenopalatine ganglion (a cluster of nerves linked to the trigeminal nerve often at the core of pain) or the vagus nerve in the neck. Though effective, these approaches are invasive and have a chance of side effects.

Nerve Stimulation Medical Devices for Migraine Headache

(Video) Cluster headaches: 'Like someone is grabbing your face' - BBC News


The fact that headaches aren’t visible makes it difficult for family, friends, and coworkers to understand the severity of what you're experiencing.

Cluster headaches can affect work attendance or work performance, for instance. This being the case, it may be helpful to discuss your condition with your managers and colleagues.

Consider discussing your concerns and feelings with a qualified therapist, who may be able to help you manage your expectations and cope with the effects of your condition.

A Word From Verywell

The intensity and severity of cluster headaches should not be underestimated. If you have been diagnosed with this condition, don’t suffer in silence; treatments are available. Your health is important, and you owe it to yourself and those around you to get help when you need it.

Symptoms of Cluster Headache

5 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. Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018;17(1):75-83. doi:10.1016/S1474-4422(17)30405-2

  2. Wei DY, Yuan ong JJ, Goadsby PJ. Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Ann Indian Acad Neurol. 2018;21(Suppl 1):S3-S8. doi:10.4103/aian.AIAN_349_17

  3. International Headache Society. Cluster Headache Classification. 2019.

  4. 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):1093-106. doi:10.1111/head.12866

  5. Mojica J, Mo B, Ng A. Sphenopalatine Ganglion Block in the Management of Chronic Headaches. Curr Pain Headache Rep. 2017;21(6):27. doi:10.1007/s11916-017-0626-8

(Video) Cluster Headaches | Risk Factors, Triggers, Signs & Symptoms, Diagnosis, Treatment

Additional Reading

An Overview of Cluster Headaches (2)

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(Video) Cluster Headaches - symptoms, pathophysiology, treatment


An Overview of Cluster Headaches? ›

A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head. Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop.

What is the main cause of cluster headaches? ›

Causes. Doctors do not know exactly what causes cluster headaches. They seem to be related to the body's sudden release of histamine (chemical in the body released during an allergic response) or serotonin (chemical made by nerve cells) in the area of a nerve in the face called the trigeminal nerve.

How do you break a cluster headache cycle? ›

There is no cure for cluster headaches. You can't do anything to prevent a cycle of cluster headaches from starting. But as soon as a cycle starts, you can take medicine that may help prevent more headaches or reduce how many you have during a cycle. You take this medicine every day during the cycle.

What gets rid of cluster headaches? ›

Acute treatments
  • Oxygen. Briefly inhaling pure oxygen through a mask provides dramatic relief for most who use it. ...
  • Triptans. The injectable form of sumatriptan (Imitrex), which is commonly used to treat migraine, is also an effective treatment for acute cluster headache. ...
  • Octreotide. ...
  • Local anesthetics. ...
  • Dihydroergotamine.

How do you stop cluster headaches? ›

A medicine called verapamil is the main treatment for preventing cluster headaches. It's taken as a tablet several times a day. Verapamil can cause heart problems in some people, so while taking it you'll need to be monitored using a test called an electrocardiogram (ECG).

What vitamin helps with cluster headaches? ›

Many studies revealed that vitamin D supplementation had an impact on reducing headache frequency, especially for migraine.

When do cluster headaches peak? ›

Timing of an Attack

Cluster headache attacks tend to occur with great regularity at the same time of day. (For this reason, cluster headaches are sometimes referred to as "alarm clock" headaches.) Most attacks occur during the night or within a few hours after falling asleep, with peak time of midnight to 3 a.m.

What nerve causes cluster headaches? ›

The nerve that's affected, the trigeminal nerve, is responsible for sensations such as heat or pain in your face. It's near your eye, and it branches up to your forehead, across your cheek, down your jaw, and above your ear on the same side. A brain condition, such as a tumor or aneurysm, won't cause these headaches.

Does drinking water help cluster headaches? ›

Dehydration can trigger (cause) a migraine headache. If you get migraines, it's essential to drink plenty of water. Staying hydrated may help you prevent a migraine attack.

How serious are cluster headaches? ›

Cluster headaches can disrupt your life for weeks or even months at a time. They tend to follow a pattern, often showing up at the same time each day. They can also wake you up an hour or two after going to bed. These nighttime headaches may feel more severe than those during the day.

What is the pain scale for cluster headaches? ›

Cluster headache pain is more intense than any other pain disorder we examined at 9.7, with the next most painful disorder, labor pain at 7.2, a full 2.5 points less on a 0–10 scale.

Are cluster headaches a disability? ›

If your cluster headaches are equal in severity to epilepsy or any other listing, or if your headaches prevent you from working, then you may qualify for disability benefits.

Is heat or cold better for cluster headaches? ›

Non-Medication Treatment of Cluster Headache

Much anxiety is generated during the day when the patient knows that nighttime brings intense, excruciating pain. Icing the area of pain may help, although sometimes heat will be more effective.

Are cluster headaches triggered by stress? ›

Cluster headache is a strictly unilateral headache that occurs in association with autonomic symptoms. Stress is a recognised precipitant of migraines, but not of cluster attacks. We describe the case of a patient having migraine for years, in whom extreme emotional stress triggered cluster headache attacks.

Does B12 help cluster headaches? ›

It seems that these vitamins, as an important part of the diet, can affect migraine characteristics. Studies have suggested that B6, B9, and B12 can reduce the severity and frequency of migraine attacks.

How much magnesium should I take for cluster headaches? ›

Magnesium oxide is frequently used in pill form to prevent migraine, usually at a dose of 400-600 mg per day. Acutely, it can be dosed in pill form at the same dosage or given intravenously as magnesium sulfate at 1-2 gm.

Is Tylenol or ibuprofen better for cluster headaches? ›

Over-the-counter pain medicines, such as aspirin, acetaminophen, and ibuprofen, usually don't work for cluster headaches. Dealing with repeated cluster headaches can lead to stress and depression, which in turn can continue the headache cycle.

Who is most likely to suffer from cluster headaches? ›

Most people who develop cluster headaches are between ages 20 and 50, although the condition can develop at any age. Smoking. Many people who get cluster headache attacks are smokers.

Do hot showers help cluster headaches? ›

According to, showers and baths are both considered to be forms of heat therapy for migraines. They say that among other heat-related remedies, a warm shower has the power to stop pain signals from traveling to the brain and increase blood flow, which can help soothe muscles.

Are there any new treatments for cluster headaches? ›

It's a kind of drug called a CGRP monoclonal antibody for the treatment of episodic cluster headache. What it does is shorten the bout. You get a dose at the start, and maybe a dose at week four, and it will reduce the frequency of attacks. Anything to reduce attacks is a good thing, and this does it by about 70%.

Do cluster headaches affect memory? ›

Patients with CH show worse working memory, disturbance of mood, and poorer quality of life compared with healthy controls.

Can neck tension cause cluster headaches? ›

Cervical spine instability can cause compression on these nerves that cause pain, loss of sensation, or cluster headaches among a large myriad of symptoms.

What vitamin deficiency causes cluster headaches? ›

Patients with cluster headache have been reported to have low vitamin D levels, although the relevance of this finding is not clear.

What vitamins are good for cluster headaches? ›

In a preliminary study, Sohn et al., reported that vitamin D deficiency is common in patients with cluster headaches, but the role of vitamin D deficiency is uncertain, except for its seasonal influence [77].

Does caffeine help cluster headaches? ›

Caffeine can provide relief for a headache.

Caffeine has vasoconstrictive properties, meaning that blood vessels narrow to restrict blood flow, thereby alleviating the pain.

Can dehydration cause cluster headaches? ›

Yes, insufficient fluid intake can cause headaches. Some people are much more prone than others to headaches related to dehydration, and people who are more susceptible can avoid the headaches by making sure they drink enough fluids daily.

What is the best energy drink for cluster headaches? ›

Treatment Hack 2: Red Bull, 5-Hour Energy, and other drinks that contain caffeine and taurine have an uncanny ability to stop an attack if caught early enough.

What over the counter medicine is good for cluster headaches? ›

How can you care for yourself at home?
  • Watch for new symptoms with a headache. ...
  • Take your medicines exactly as prescribed. ...
  • If your doctor recommends it, take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).

What is the nickname for cluster headaches? ›

Cluster headache (CH) is arguably the most severe pain condition that afflicts humans. The severity of the pain has earned it the nickname “suicide headache”.

What is the most painful headache in the world? ›

"Cluster headache is probably the worst pain that humans experience.


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2. #099 What is CLUSTER HEADACHE, and how to treat it?
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4. Cluster Headaches - A Comparison to Migraine
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6. Cluster Headaches, Signs and Symptoms, Treatment
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