Headache and facial pain

Cluster headache

Short, extremely severe attacks on one side around the eye, often several times a day and during distinct periods.

More than “a very bad headache”. The fixed rhythm, eye or nasal symptoms and strong urge to move make cluster headache a distinct neurological disorder.

A distinct headache disorder

What is cluster headache?

Cluster headache belongs to the trigeminal autonomic cephalalgias. Attacks are strictly one-sided and often occur with automatic reactions of the eye, nose or eyelid on that same side.

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Short but extreme

According to international criteria, an untreated attack lasts 15 to 180 minutes and can occur from once every other day to eight times a day.

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In cluster periods

In episodic cluster headache, attacks recur for weeks or months and are followed by remission. In chronic cluster headache, a longer remission is absent.

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Cause not fully understood

Why cluster headache develops is not known precisely. Its daily and seasonal rhythm suggests a role for biological timing, but this does not explain everything.

The pattern matters

What can an attack look like?

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Extremely severe pain

Sharp, burning or boring pain around or above one eye or at the temple.

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Eye and nose

A red or watery eye, blocked or runny nose, sweating, a swollen or drooping eyelid, or a smaller pupil on the painful side.

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Unable to keep still

Many people pace, rock or move during an attack. This often differs from migraine, when rest and darkness may be preferred.

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At fixed times

Attacks may return at similar times, including at night, and can occur several times within 24 hours during an active cluster.

Cluster headache can resemble migraine or nerve pain

Nausea or light sensitivity can sometimes occur too. One feature does not automatically rule out another headache disorder; the complete pattern and assessment guide the diagnosis.

Timeline

Episodic and chronic cluster headache

Episodic cluster headache

Cluster periods lasting weeks to months are separated by a pain-free remission of at least three months.

Simplified illustration: cluster, remission, new cluster.

Chronic cluster headache

Attacks continue for one year or longer without remission, or with remission periods shorter than three months.

Frequency can vary; “chronic” does not necessarily mean the same number of attacks every day.

Diagnosis and safety

How is it assessed?

Diagnosis mainly depends on the attack history and neurological examination. A first attack resembling cluster headache will usually lead to specialist assessment.

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Attack diary

Record time, duration, side, eye and nasal symptoms, restlessness, medication and effect. A photograph of the eye during an attack can sometimes add useful information.

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Imaging

A neurologist decides whether MRI is needed to exclude other causes or mimics. A normal scan does not make the attacks less real.

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Reassess change

A switch to the other side, a new neurological symptom or a clearly different pattern should be assessed again.

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First sudden, extremely severe headache?

Seek urgent medical advice. Do not assume it is cluster headache when the attack is new or clearly different.

Attack and prevention

Which treatments can help?

Because attacks peak quickly, ordinary painkillers are usually too slow. Treatment should include a personalised acute plan and often preventive treatment, coordinated with a doctor and neurologist.

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Treating an attack

Medical oxygen through a suitable non-rebreathing mask and subcutaneous sumatriptan are important fast treatments. A nasal triptan may be an alternative for longer attacks. Prescription, contraindications and safe use need individual discussion.

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Preventing attacks

Verapamil is generally the first preventive option and dose increases require ECG monitoring. Transitional treatment, a greater occipital nerve injection or other medication may be considered in specialist care.

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Self-treatment with oxygen or medication is not a safe plan

The oxygen system, mask and flow rate matter. Verapamil can affect cardiac conduction and sumatriptan is not suitable for everyone. Have the acute plan prescribed personally.

Life during and between attacks

More control during a cluster period

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Prepare the acute plan

Keep oxygen or medication accessible and make sure people at home or work know what is happening and when help is needed.

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Alcohol during an active cluster

Alcohol can trigger an attack during an active cluster period. Outside such a period, that association does not apply to everyone.

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Work and sleep

Night-time attacks, fear of the next attack and recovery can be exhausting. Discuss temporary adjustments and occupational support where available.

A typical care trap: a rare disorder can have a recognisable pattern and still be treated for years as migraine, sinus trouble or stress. Ask which features support the diagnosis and who coordinates the complete treatment plan.

Share your experience

How quickly was cluster headache recognised for you?

We are looking for experiences about recognition, access to oxygen, prevention, work and coordination between professionals.