What is Cluster headache?
Cluster headache is the most common of the trigeminal autonomic cephalalgias. The hypothalamus — the part of the brain that controls the body clock — is thought to play a key role, which is why attacks often strike at the same time of day, frequently waking people from sleep, and cluster periods may recur in the same season each year.
It is much less common than migraine and affects men about three times as often as women. It usually begins between the ages of 20 and 40. Smoking is common among people with cluster headache, and during a cluster period alcohol can trigger an attack within minutes.
Most people have the episodic form: cluster periods of weeks to months, separated by pain-free periods of months or years. In chronic cluster headache, pain-free periods are shorter than three months or absent.
Symptoms of Cluster headache
- Extremely severe, boring or burning pain around or behind one eye or in the temple
- Attacks lasting 15 minutes to 3 hours
- One to eight attacks a day, often at the same times, frequently at night
- On the same side as the pain: watering and redness of the eye, a drooping eyelid, a smaller pupil
- A blocked or runny nostril and facial sweating on the same side
- Restlessness and pacing during an attack
People with migraine usually want to lie still in a dark room; people with cluster headache are restless and need to move during an attack. This difference is an important clue.
How cluster headache differs from migraine
- Attack length: 15–180 minutes in cluster headache, 4–72 hours in migraine
- Behaviour: restlessness in cluster headache, lying still in migraine
- Eye and nose signs on the side of the pain are prominent in cluster headache
- Timing: same time of day, often at night, in bouts
- More common in men (migraine is more common in women)
When should you see a neurologist?
Anyone with very severe one-sided headaches with the features above — especially attacks that wake them at night — should be seen by a neurologist. Cluster headache is often mistaken for a dental, sinus or eye problem, and diagnosis can be delayed for years.
A first-ever, very severe, sudden headache — or headache with loss of vision, weakness or confusion — needs urgent assessment.
How is Cluster headache diagnosed?
The diagnosis rests on a detailed description of the attacks and a neurological examination. A photo or video taken during an attack (showing eye redness or a drooping eyelid) can be very helpful.
Everyone diagnosed with cluster headache should have an MRI scan of the brain at least once to rule out rare structural causes near the pituitary gland and brainstem; pituitary hormones may be checked if needed. Night-time attacks can also prompt an assessment for sleep apnea.
Other trigeminal autonomic headaches such as paroxysmal hemicrania and SUNCT/SUNA are also considered, because some respond to different medicines.
How is Cluster headache treated?
Treatment has three parts: stopping attacks, a short “bridging” treatment and prevention.
Stopping an attack
- 100% oxygen through a non-rebreather mask at a high flow rate (12–15 litres per minute) for 15–20 minutes stops attacks in many people and has few side effects
- Triptans given by injection under the skin or as a nasal spray work quickly
- Painkillers taken by mouth act too slowly to help most attacks
Bridging treatment
At the start of a cluster period, a short course of steroids or a greater occipital nerve block — an injection of local anaesthetic (with or without steroid) at the back of the head on the side of the pain — can reduce attacks while preventive medicine starts working.
Preventive treatment
A preventive medicine is taken throughout the cluster period. The most commonly used is a calcium-channel blocker, increased step by step with heart-rhythm (ECG) monitoring. Lithium or certain anti-seizure medicines may also be used. Prevention is tapered off after the cluster period ends.
For people who know when their clusters tend to start, beginning prevention right at the start of a bout reduces the number of attacks — so we agree a plan for rapid contact when a new period begins.
Treatment timeline and your stay in Istanbul
The first consultation takes 30–45 minutes; an MRI can be scheduled the same or the next day. Prevention is continued throughout the cluster period, usually several weeks to a few months.
For patients from abroad, the consultation, MRI and — if needed — a nerve block can be fitted into 1–2 days in Istanbul. Dose adjustments and follow-up can continue online.
Follow-up after treatment
- Avoid alcohol completely during a cluster period
- Stopping smoking is good for long-term health and medication safety
- Keep regular sleep and avoid daytime naps
- Keep an oxygen cylinder and the correct mask at home
- Note the months in which your clusters start so that prevention can begin early
Risks and what to watch for
Oxygen is generally safe, but is used with caution in people with chronic lung disease. Triptans may not be suitable for people with heart or circulation problems. Preventive medicines require periodic checks of heart rhythm, blood pressure and blood tests. Steroids are kept short. Nerve blocks may cause temporary soreness, bruising and occasionally light-headedness.
Frequently asked questions about Cluster headache
Why is cluster headache sometimes called “suicide headache”?
Because the pain is so severe. Today, oxygen, triptans, nerve blocks and preventive medicines can greatly reduce the severity and frequency of attacks. What matters most is an early, correct diagnosis.
Is cluster headache hereditary?
A small proportion of people have a relative with cluster headache, so genes may play a part, but most people have no family history.
Can I use oxygen at home?
Yes. With a prescription, a home oxygen cylinder and the right mask can be used as soon as an attack starts. Using the correct mask and a high flow rate is essential for it to work.
Is cluster headache confused with sinusitis or toothache?
Often, because the pain is around the eye and cheek and comes with a runny nose. Some people even have unnecessary dental or sinus procedures. A neurological assessment is key to the right diagnosis.
Does a nerve block help cluster headache?
A greater occipital nerve block, especially at the start of a cluster period, can reduce attack frequency in many people. The effect varies and it is used together with preventive medicine.
How long do cluster periods last?
In episodic cluster headache they usually last 6–12 weeks and may occur once or twice a year. In the chronic form there is little or no pain-free time.
Why is an MRI needed?
Very rarely, similar attacks are caused by a structural problem near the pituitary gland or brainstem. An MRI excludes this; if it is normal, treatment continues as for cluster headache.
Do I need to take preventive medicine outside a cluster period?
In episodic cluster headache, preventive medicine is taken only during the cluster period and is then tapered off under supervision. In chronic cluster headache, prevention may be continued for longer.
Can women have cluster headache?
Yes. Although it is more common in men, women are affected too and are often misdiagnosed with migraine. Very severe, short, one-sided attacks around the eye at the same time each night should suggest cluster headache regardless of sex.
This page is for general information only and does not replace a medical consultation. Please consult a physician for diagnosis and treatment. Results vary from person to person.
