---
title: "Cluster headache: Symptoms & Treatment | HealthAnswers"
description: "Cluster headache — excruciating one-sided head pain in clusters, triggers, acute treatment with sumatriptan and oxygen, and preventive options."
url: https://healthanswers.co.uk/conditions/cluster-headache/
robots: noindex
---

# Cluster headache: Symptoms & Treatment | HealthAnswers

Health A–Z

Cluster headache — excruciating one-sided head pain in clusters, triggers, acute treatment with sumatriptan and oxygen, and preventive options.

Written by HealthAnswers editorial team Medically reviewed by [HealthAnswers UK doctor review panel](https://healthanswers.co.uk/our-doctors/) Reviewed 3 July 2026

## Quick answer

What is cluster headache? Cluster headache is a rare but extremely severe primary headache — intense pain around one eye, often with watering eye, blocked nose, and droopy eyelid on the same side. Attacks last 15 to 180 minutes and occur in clusters (weeks to months) often at the same time daily — especially during sleep. Much more common in men. Acute treatment — high-flow oxygen through mask and sumatriptan injection or nasal spray. Verapamil is main preventive. See a GP urgently for new severe one-sided headaches around the eye — neurology referral for diagnosis and specialist treatment.

## Who is this page for?

This page is for people in the UK who want a plain-English overview of Cluster headache, including when to seek help and what NHS care usually involves. It explains general information, not what is wrong with you personally.

## Who should skip this page?

Skip this page if you need a diagnosis, a prescription, or emergency care. It cannot replace a GP, pharmacist, NHS 111 or 999. If you are in immediate danger, call 999; for urgent advice that is not life-threatening, call 111 in England, Scotland or Wales, or use your GP out-of-hours service in Northern Ireland.

On this page 8 sections

## Key facts about cluster headache

- Cluster headache affects about 1 in 1,000 people — often misdiagnosed as migraine or sinus problem for years.
- Pain described as worst imaginable — sharp, burning, stabbing around eye — patients may pace or bang head unlike migraine where rest helps.
- Attacks strictly one-sided — autonomic features on same side — red eye, tearing, nasal congestion, ptosis.
- High-flow oxygen 12–15 L/min via non-rebreather mask aborts attack in many within 15 minutes.
- Not life-threatening but causes severe disability — specialist headache service improves management.

## Cluster headache — the suicide headache

**Cluster headache** belongs to **trigeminal autonomic cephalalgias (TACs)** — **primary headache** with **severe unilateral pain** and **ipsilateral autonomic features**.

**~1/1000 prevalence** — **3:1 male** — **peak 20–40**

**Nicknamed “suicide headache”** — **pain intensity unmatched** among primary headaches

## Attack characteristics

**Diagnostic criteria (brief):**

- Severe unilateral orbital/temporal/supraorbital pain

- 15–180 minutes duration

- Frequency every other day to 8 daily

- At least one ipsilateral autonomic sign: Conjunctival injection

- Lacrimation

- Nasal congestion/rhinorrhoea

- Forehead/facial sweating

- Miosis/ptosis

- Eyelid oedema

**Restlessness** — **key differentiator from migraine**

## Episodic vs chronic

**Episodic cluster:**

- Cluster periods — weeks to months

- Remission ≥3 months

**Chronic cluster:**

- No remission over 12 months

- Harder to treat

**Circadian and circannual rhythm** — **spring/autumn onset common**

## Triggers

**Alcohol** — **reliable trigger during cluster period only**

**Nitroglycerin** — **medical provocation test**

**Sleep** — **attacks often 1–2 hours after falling asleep**

**Strong odours** — **solvents**

## Acute treatment

| Treatment | Details |
| --- | --- |
| Oxygen | 12–15 L/min, non-rebreather, 15 min |
| Sumatriptan SC | 6 mg — onset ~10 min |
| Sumatriptan nasal | 20 mg if needle aversion |
| Zolmitriptan nasal | Alternative |

**Avoid:**

- Oral triptans alone — too slow

- Oxygen with significant COPD without advice

## Prevention

**Verapamil:**

- Start low, titrate — up to 960 mg/day

- ECG before and during — heart block risk

**Bridge:**

- Prednisolone taper — rapid cluster control short term

**Other:**

- Lithium

- Topiramate

- Greater occipital nerve block

- Galcanezumab — episodic cluster

## Secondary causes — must exclude

**MRI brain with attention to pituitary and cavernous sinus**

**Red flags for secondary:**

- Atypical autonomic pattern

- Abnormal examination between attacks

- Older age first onset

## Living with cluster

**Headache diary** — **timing proves cluster pattern**

**Workplace adjustments** — **predictable sick leave during cluster**

**OUCH UK peer support**

**Suicidal ideation during attacks common** — **crisis plan**

Waking **same time nightly with eye pain and tears** — **not sinusitis** until proven — **GP + neurology** — **oxygen prescription saves nights**.

## ! When to see a GP about cluster headache

See a GP urgently for repeated severe one-sided headaches around the eye with eye watering or nasal blockage — especially if waking you from sleep at same time nightly. Same-day if first ever thunderclap headache (sudden maximal pain) — exclude subarachnoid haemorrhage. GP refers to neurology or headache clinic — MRI brain to exclude secondary causes. Do not accept years of misdiagnosis — insist on specialist review if pattern fits cluster.

## Common questions about cluster headache

What does a cluster headache attack feel like? Excruciating unilateral pain around or behind eye — peaking within minutes, lasting 15 to 180 minutes. Restlessness — pacing, rocking — unlike migraine. Ipsilateral autonomic symptoms — lacrimation, conjunctival injection, rhinorrhoea, miosis/ptosis, forehead sweating. Can occur up to 8 times daily in active cluster period. How is cluster headache different from migraine? Cluster — shorter attacks (under 3 hours), strictly unilateral orbital, prominent autonomic eye/nose signs, agitation not lying still, male predominance, clock-like regularity including nocturnal timing. Migraine — longer (4–72 hours), throbbing, nausea/vomiting, photophobia, prefers dark quiet room, more common in women. How do you treat a cluster headache attack? High-flow 100% oxygen 12–15 L/min through non-rebreather mask for 15–20 minutes at attack onset. Subcutaneous sumatriptan 6 mg — fast and effective — max 2 doses daily. Sumatriptan nasal spray alternative. Oral triptans too slow for many. Avoid oxygen if COPD without specialist advice. What prevents cluster headache attacks? Verapamil — main preventive — ECG monitoring required. Short transitional steroids (prednisolone) bridging until verapamil works. Greater occipital nerve blocks. Galcanezumab (CGRP antibody) for episodic cluster in some cases. Avoid alcohol during cluster period — triggers attacks. Can cluster headache be cured? No permanent cure — episodic cluster has remission periods between clusters — months to years. Chronic cluster — no remission over a year — harder to treat. Deep brain stimulation or occipital nerve stimulation for refractory chronic cluster in specialist centres.

## Sources

- [NHS — Cluster headaches](https://www.nhs.uk/conditions/cluster-headaches/)
- [NICE — Headaches — diagnosis and management](https://www.nice.org.uk/guidance/cg150)
- [OUCH UK — Organisation for Understanding Cluster Headache](https://ouchuk.org/)