Cluster Headache Symptoms, Causes & Treatment Options

A headache is defined as pain in any region of the head. Headaches can take on multiple qualities that vary in severity, symptoms, and onset. Cluster headaches are particularly painful and have a distinct pattern of symptoms.

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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?


Cluster headaches are a type of primary headache. A primary headache is a headache that is due to the headache condition itself and not due to another cause or underlying condition.

Cluster headache is a rare disorder. They are often considered “one of the worst pains known to man” [1], [2] and can significantly affect quality of life. These headaches occur in bouts or “clusters” in which the individual experiences multiple attacks per day, for many days in a row. In the acute or episodic form, patients will have periods of remission in which they have no headaches for a month or more. However, in the chronic form, patients have at least a year of pain without remission or are only pain-free for a few weeks or days. Less than 20% of cluster headache patients have the chronic form [3].

Cluster headache is more common in men than women and usually starts when people are in their early twenties. Certain triggers are associated with cluster headache and can include factors such as season changes, drug use, increased stress, and changes in diet.

There is no cure for cluster headache, but there are effective treatment options that work to decrease symptoms and manage attacks, even in the chronic form of the disease.

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Cluster Headache Symptoms

Main symptoms

A particular pattern of symptoms occurs in cluster headache. These symptoms include:

  • Pain occurring on one side of the head (unilateral), behind the eye and around the temple (orbital): The pain can radiate (spread) to other parts of the face or forehead but usually starts from the same place.
  • Quality of pain that is intense, constant, burning, or stabbing
  • Autonomic symptoms

Autonomic symptoms

These refer to symptoms related to unconscious body functions such as heart rate, blood pressure and constriction and relaxation of vessels. Cluster headaches are associated with unilateral autonomic symptoms such as:

  • Red eyes
  • Eyelid swelling
  • Tearing of the eyes
  • Nasal congestion
  • Runny nose
  • Drooping eyelid

In chronic cluster headache, these symptoms usually involve the same side of the face but can sometimes switch.

Cluster Headache Causes

Though the specific cause of most headaches is not well understood, it is thought that headaches happen when there is increased activity or dysregulation of pain-sensitive structures in the head such as blood vessels, muscles, tissues surrounding the brain and even teeth.

The cause of cluster headache is not fully understood. Cluster headache belongs to a group of disorders called the trigeminal autonomic cephalalgias [2]; these conditions affect the sensitivity of a large nerve in the face called the trigeminal nerve that controls sensation in the face and functions such as biting and chewing. It is hypothesized that the sensitivity of the trigeminal nerve can be affected in three ways.


This theory proposes that cluster headaches are caused by dysfunction or inflammation of the blood vessels in the part of the brain that activate the trigeminal nerve. In addition, dilation of blood vessels around the trigeminal nerve can compress the nerve and cause undue pressure that may lead to symptoms.


Initially, cluster headache was not classified as a genetic disease. However, in recent years, more evidence has shown that cluster headaches may have a familial component. Twin and family studies have demonstrated results that suggest cluster headache can be passed down in both autosomal dominant and recessive patterns [4].

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Treatment Options, Relief, and Prevention for Cluster Headache


Treatment for cluster headache includes alleviating pain during attacks and prophylactic treatment to reduce the number of daily attacks.

  • Pain management: Medications that are inhaled or subcutaneous (under the skin) work faster than medications taken by mouth and are the best option for acutely managing cluster headache pain. The treatments of choice are 100 high-flow inhaled oxygen and subcutaneous sumatriptan, which is a drug that vasoconstricts the blood vessels and may help with pressure on the trigeminal nerve.

  • Prophylaxis: Verapamil (a drug also used in hypertension) is the first therapy in both acute and chronic cluster headache for prophylaxis. Talk to your healthcare provider about other drugs that can be used such as Topiramate, lithium and short dose corticosteroids.


Since cluster headaches can be trigger dependent, prevention of attacks involves making lifestyle and behavioral changes that may help combat symptoms.

  • Decrease stress: Reducing stress is much easier said than done, but taking up activities such as yoga or meditation can give you the tools to help deal with life’s stressors in healthy ways.
  • Avoid alcohol and smoking: Alcohol is the only recognized trigger of cluster headache. Avoid alcohol during bouts to lessen pain. Stopping smoking may help prevent attack onset.
  • Get adequate sleep: A good night’s rest is the brain’s way of recovering each day in order to work well the next. Your brain can manifest its exhaustion and lack of recovery in the form of headaches that may worsen with movement of the head.

When to Seek Further Consultation for Cluster Headache

If you experience abrupt, severe headache or headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties, seek medical attention immediately. These symptoms could be signs of serious conditions, such as stroke or meningitis.