HomeHealth articlescluster headacheCluster Headaches

Cluster Headaches - Symptoms, Triggers, Management, and Modes of Prevention

Verified dataVerified data
Cluster Headaches - Symptoms, Triggers, Management, and Modes of Prevention

4 min read


Cluster headaches are excruciatingly severe headache episodes that come and go in repeating cycles throughout the year with periods of remissions in between.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Abhishek Juneja

Published At August 2, 2022
Reviewed AtJanuary 22, 2024

What Are Cluster Headaches?

They are rare types of headaches occurring in a cluster or group. Individuals experience brief episodes of excruciatingly severe headaches lasting for one to three hours at every cluster headache attack. Similarly, they can recur about one to eight times a day and last for weeks to months. The attack period is followed by a period of remission when the individual is free of headaches, and then another cycle of cluster headaches commences. This pattern runs in a cycle. Pain associated with cluster headaches is said to be the most severe type of headache among all the existing types of headaches. It has a sharp, piercing, and stabbing nature and badly affects one’s day-to-day activities and work.

What Are the Symptoms of Cluster Headaches?

The typical symptoms of cluster headaches are:

  • Drilling, burning type of pain on one side of the head.

  • Pain starts in the temple area, behind the eye, or around it.

  • Usually, it begins at night, waking one up from sleep.

  • Occasionally, the side affected may change in the next attack.

  • Puffed up watery eyes that keep tearing up the entire time of the attack.

  • Redness in the eye.

  • Runny nose or stuffy nose.

  • A flushed face that keeps sweating.

  • On the affected side of the head, the pupil of the eye looks shrunken, and the eyelids droop.

  • One tends to stay agitated and restless throughout the episode; choose to pace around in the room, rock the torso, compress the painful side or bang the head.

  • The pain might end abruptly, leaving the affected exhausted.

  • Often one shows aggressiveness, anxiety, and depression during cluster bouts; rarely, some individuals show suicidal tendencies.

How Long Does a Cluster Headache Last?

Cluster cycles come and go roughly one to two times in a year, and most of the time, one can predict the attack. For most people, it happens during the same season every year. Each episode lasts approximately fifteen minutes to three hours. Depending on the individual, it may happen once daily, multiple times in a day, or on alternate days. For individuals with a long-lasting (chronic) problem, cluster bouts last for about a year, with remissions of less than a month.

What Are the Triggers and Causes for Cluster Headaches?

People between the age group 20 to 40 seem to have a higher prevalence of cluster headaches, while men have slightly higher chances than women. Sometimes cluster headaches are passed on from one generation to the next among families. Individuals who suffered injuries to the head also have higher chances of developing cluster headaches. The exact cause of cluster attacks is yet to be identified. However, it seems to relate to the sudden release of certain chemicals in the body, such as histamine or serotonin. The blood vessels in certain areas inside the brain (trigeminal nerve) seem to get dilated. It is also linked to the activity of the organ hypothalamus in the brain that controls the biological clock of body functions.

Apart from this, a few factors may trigger a cluster bout. They are:

  • Excessive consumption of alcohol.

  • Cigarette smoking.

  • Exposure to bright lights.

  • Watching screens for a prolonged period.

  • Exposure to strong, pungent smells.

  • Being in high-altitude terrains.

  • Heavy exercise or physical exertion.

  • Increased sexual activity.

  • Increase in body temperature due to weather, exertion, or a hot bath.

  • Emotional stress.

  • Overuse of cocaine.

  • Consuming certain food types that contain nitrates.

How Can One Distinguish Between Migraine and Cluster Headache?

Many times, cluster headaches get misdiagnosed as migraine disorders. It is often observed that during a migraine attack, people have a tendency to stay still and get confined to a dark and quiet room, but cluster headaches cause them to keep moving around and stay agitated. Besides, cluster headache attacks last for shorter durations compared to migraine attacks.

How Are Cluster Headaches Diagnosed?

Identifying cluster headaches clinically requires a meticulous assessment process. Analyzing the medical history, signs, and symptoms are significant. Based on these, the doctor will try to figure out the underlying cause for cluster bouts. In addition, there will be a neurological assessment. One should rule out any other types of headaches as well. Imaging studies of the brain and blood vessels in the head also help evaluate it. Computed tomography scans (CT) and magnetic resonance imaging (MRI) help to rule out other conditions that cause headaches, such as brain tumors.

What Is the Treatment for Cluster Headaches?

If left untreated, there is a chance they increase both in duration and frequency. Hence, treatment includes immediate measures to relieve the symptoms and stop a cluster attack and ways to reduce the frequency and duration of future occurrences.

Following are the acute treatment strategies:

  1. At the time of the headache episode, a facemask with high-flow oxygen is effective in ending the attack.

  2. The doctor may prescribe steroid tablets or injections such as Prednisone to relieve the initial symptoms of cluster headache.

  3. Some migraine medications, such as Sumatriptan, Zolmitriptan (nasal spray), and Dihydroergotamine, are effective in stopping cluster bouts. These medicines help constrict the blood vessels in the brain, which eases the pain. Injectable medications are preferred over oral tablets for faster effect, as this type of headache gathers maximum intensity within minutes of onset.

  4. For some affected individuals, sending electrical stimulation into the head to terminate the attack is effective (transcutaneous vagus nerve stimulation).

  5. Local anesthetic injections (occipital nerve block) around the nerves in the back of the head give relief to some people.

Preventive strategies include:

  1. Calcium channel blockers like Verapamil are prescribed to prevent cluster headaches from occurring.

  2. Antiseizure drugs, Melatonin, and Lithium are effective in reducing the frequency of cluster headaches.

  3. Finding the association between individual triggers that cause a cluster attack helps with future prevention. Keeping a journal on one’s lifestyle, habits, and food intake is an excellent way to explore the individual triggering factors since triggers vary from person to person. Often, avoiding the triggers is the best way to prevent cluster headaches.


Though relatively uncommon, cluster attack is a debilitating type of headache disorder that requires an accurate diagnosis to implement the right kind of treatment. In addition, understanding the attack pattern is critical in effective prevention since they recur almost every day for days, weeks, and months. Finally, an important fact to remember is that cluster headache is not life-threatening and does not damage the brain. And for most people, the condition gets better with age.

Dr. Abhishek Juneja
Dr. Abhishek Juneja



cluster headache
Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Do you have a question on

cluster headache

Ask a doctor online

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy