Cluster Headache (First Attack) Symptoms, Causes & Treatment Options

A cluster headache is a severe headache that is on one side of your head that may be associated with specific symptoms such as redness of the eye, a watery eye, eyelid drooping, and nasal congestion. The headaches are not life-threatening and can often be managed by medications. [1]

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Cluster Headache (First Attack)?


Cluster headaches are characterized by severe unilateral headache attacks that last from 15 minutes to 3 hours if untreated. Headaches are accompanied by ocular symptoms, nasal symptoms, sweating, or agitation. If you suffer from cluster headaches, they often occur every day and can happen multiple times a day. They are also associated with your circadian rhythm and often occur at night after you are asleep for a few hours. It is common to have months of headache-free periods; this is known as episodic cluster headaches. Headaches often begin before the age of thirty and are more common in men than in women. [2]

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Cluster Headache (First Attack) Symptoms

Main symptoms

The pain that is experienced during a cluster headache is unilateral and severe in intensity. [3]

  • Severe pain that is burning or throbbing in sensation
  • Unilateral pain near your eye that radiates up to your forehead or down to your jaw
  • Pain that lasts 15 minutes to 3 hours
  • Scalp tenderness on the affected side
  • Pulsating vessels on the affected side

Other symptoms

Cluster headaches are associated with autonomic symptoms, or symptoms that occur due to activation of a specific part of your nervous system. Examples of autonomic symptoms that may be associated with your cluster headache are listed below. [3]

  • Excessive sweating
  • Facial flushing on the side of the headache
  • Nasal discharge or congestion
  • Tearing of the eye on the side of the headache
  • Swelling or drooping of the eye on the side of the headache
  • Shrinking of the pupil in the eye that is on the same side of the headache
  • Reddening of the eye that is on the side of the headache
  • Unilateral tooth or gum pain

Frequency of symptoms

Cluster headaches occur in grouped patterns which is known as a cluster period. Most individuals who experience cluster headaches will have multiple headaches a day during a specific time period that is often associated with their circadian rhythm. Additionally, the headaches occur at the same time every day for multiple days in a row. These periods of headaches often last from weeks to months and then disappear completely. A percentage of individuals who have experienced a cluster period will have recurrent attacks.

Cluster Headache (First Attack) Causes


Cluster headaches are a type of primary headache, or a type of headache that occurs because of excessive stimulation of pain-sensitive areas in your head, rather than an underlying disease such as an aneurysm or tumor. [4] The exact cause of the headache is not known; however, it is thought that abnormalities to the hypothalamus, or a structure in your brain, can predispose you to experiencing cluster headaches. This type of headache is not associated with triggers such as diet, stress, hormones, or sleep. However, once you are experiencing a cluster headache, alcohol can increase the pain that is experienced. Risk factors for cluster headaches include being male that is 20 to 50 years old, smoking, and having a family member that also suffers from cluster headaches. [2]

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Treatment Options, Relief, and Prevention for Cluster Headache (First Attack)


Unfortunately, there are no existing cures for cluster headaches. Instead, there are various treatments that you can use to decrease the severity of the symptoms that occur when you experience a cluster headache. Predominantly, the goal of these therapies is to reduce your pain. The most effective treatment for the headache pain associated with cluster headaches is oxygen therapy. Oxygen inhibits the nerves that fire to trigger your pain. Often, when you use oxygen for fifteen minutes, your pain will subside significantly and your attack will be interrupted. Oxygen utilization is safe; however, it requires you to have a portable unit of oxygen with you to treat your quick onset pain.

In addition to oxygen, your doctor may recommend an injectable or inhalational triptan medication. Because the symptoms with cluster headaches are so acute in onset, triptan injections are much more effective at curbing symptoms in comparison to oral triptan medications. This is because the medication will enter your bloodstream quickly more quickly if injected or inhaled. Octreotide is another injectable medication that is sometimes used for the treatment of cluster headaches. It is a synthetic form of the hormone somatostatin; however, it has not been demonstrated to be as successful at treating cluster headache pain as injectable triptans.

Other choices for treatment of the pain associated with cluster headaches include ergotamine and lidocaine. Intravenous ergotamine can provide very rapid relief; however, it is not easy to administer in comparison to injectable and intranasal forms. The injectable and intranasal ergotamine forms are less effective than triptans. Less commonly, your doctor may recommend intranasal lidocaine for the management of your symptoms. [4]


Various medications may be prescribed to you by your doctor to help decrease the frequency of cluster headaches that you experience. Based on the frequency and severity of your symptoms, your doctor will determine what is the best medication for you. The first-choice medication for the prevention of cluster headaches is a calcium channel blocker such as verapamil (Verelan). If you are prescribed a calcium channel blocker for long-term prevention of cluster headaches, you should see a doctor regularly as it can affect your heart which will subsequently need to be monitored while you are on the medication. Calcium channel blockers may also cause you to have an upset stomach, swelling in your legs, and a mild headache.

An alternative medication that may be prescribed to you is a corticosteroid such as prednisone. These medications are fast-acting and work by decreasing the inflammation that causes you to experience pain during your cluster headache. Corticosteroids are a short-term therapy for cluster headaches, and thus, if you require longer-term management for recurrent cluster headaches, calcium channel blockers are a better choice. Steroids are also associated with more serious side effects if taken for long periods including high blood sugar, high blood pressure, and cataracts.

If your cluster headaches are not well prevented by the above medications, your doctor may prescribe you lithium or recommend a nerve block. Lithium is an appropriate therapy if you suffer from chronic headaches; however, it is associated with more serious side effects than calcium channel blockers. Lithium may cause disruption to your thyroid, kidneys, and liver, and thus, you will require close monitoring of these medications by your primary care doctor.

Nerve blocks are often administered in conjunction with medications used for the long-term prevention of cluster headaches such as calcium channel blockers and lithium. Your doctor will inject either an anesthetic (or numbing medication) or steroid (or anti-inflammatory medication) into a specific nerve in the back of your head to improve your pain if you suffer from chronic cluster headaches. [4]

When to Seek Further Consultation for Cluster Headache (First Attack)

If you are having a headache that you believe is attributable to a cluster headache, you should see your outpatient doctor who will assess your symptoms and who then may prescribe you oxygen or an alternative treatment for your pain. Additionally, if you suffer from frequent cluster headaches, you should ask your doctor about any of the chronic therapies listed above that can help reduce the number of headaches that you experience.

If your headache severity increases or is associated with numbness or tingling in your face, drooping of your lip, or weakness in your face, you should go to an emergency room immediately for evaluation. Additionally, if the features of your headache change you should seek out care as quickly as possible; this may mean you have a different pathology than a cluster headache that will be managed differently.

Moreover, if you require medications to either treat or prevent your headaches, you should see a doctor regularly. As mentioned above, several therapies that are effective in treating cluster headaches are associated with side effects and should be monitored closely to ensure that you are tolerating the medications. Your doctor will also determine the best regimen for you based on your symptoms and how you respond to various therapies. [1] [5]