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Cluster headaches




It's often felt around the eye, temple and sometimes face. It tends to affect the same side for each attack.

People often feel restless and agitated during an attack because the pain is so intense, and they may react by rocking, pacing or banging their head against the wall.

You may also get 1 or more of the following symptoms:

  • a red and watering eye
  • drooping and swelling of 1 eyelid
  • a smaller pupil in 1 eye
  • a sweaty face
  • a blocked or runny nostril

The attacks generally last between 15 minutes and 3 hours, and typically occur between 1 and 8 times a day.

The exact cause of cluster headaches is not clear, but they have been linked to activity in part of the brain called the hypothalamus.


Some people who get cluster headaches have other family members who also get them, which suggests there may be a genetic link.


Pattern of attacks

Cluster headaches usually happen every day, in bouts lasting several weeks or months at a time (typically 4 to 12 weeks), before they subside.

A symptom-free period (remission) will often follow, which sometimes lasts months or years before the headaches start again.

People tend to get cluster headaches at the same time each day. For example, they often wake up with a headache within a couple of hours of going to sleep.

They'll often get cluster headaches every year for many years and they may be lifelong. They tend to happen at similar times of the year, commonly in the spring and autumn.

When to get medical advice

You should see a GP as soon as possible the first time you experience what you think may be a cluster headache.



Typically, with cluster headaches the brain scan is normal and the diagnosis is made on the basis of your symptoms without the need for further tests.


Cluster headaches are not life threatening, but they can cause severe pain and significantly affect your quality of life.

Over-the-counter painkillers, such as paracetamol, are not effective for cluster headaches because they're too slow to take effect.

Instead, you'll need to have one or more specialist treatments.

3 main treatments are available to relieve pain when taken soon after a cluster headache starts.

These are:

  • sumatriptan or zolmitriptan nasal spray – which can be used if you do not want to have injections

These treatments usually relieve the pain of a cluster headache within 15 to 30 minutes.

The Organisation for the Understanding of Cluster Headache (OUCH UK) has more information about the medicines used to treat cluster headaches.

Transcutaneous vagus nerve stimulation

Transcutaneous vagus nerve stimulation (TVNS) is a fairly new treatment that uses low-voltage electrical currents to stimulate a nerve in the neck. 




TVNS can be used to treat cluster headaches when you get them, and can also be used between attacks to try to prevent them happening. But TVNS may not help everyone with cluster headaches.


There's also a new portable TVNS device called gammaCore. NICE has said that gammaCore can be effective for some people and reduce the need for medicines.

Stimulation device implantation

If you've had cluster headaches for a long time and other treatments have not worked, surgery to implant a stimulation device may be recommended.


It emits electrical currents that stimulate an area of the parasympathetic nervous system thought to be associated with cluster headaches.



NICE has recommended that the treatment is safe for short-term use (up to 2 months) under close specialist supervision.


Avoiding triggers

Avoiding the triggers of cluster headaches can help prevent them.

For example, you should not drink alcohol during a cluster headache bout.

You should also try to avoid strong-smelling chemicals, such as perfume, paint or petrol, which can often trigger an attack.


Smoking has also been linked to an increased risk of getting cluster headaches, so you should consider giving up smoking (if you smoke).


Your doctor may prescribe medicine to prevent cluster headaches during a bout.




Other treatments may be considered if verapamil is not effective. These may include corticosteroids, lithium medicine and local anaesthetic injections into the back of the head (occipital nerve blocks).

Preventative treatments can vary in effectiveness from person to person.


Help and support



OUCH (UK) has an answerphone messaging service you can call. The number is 01646 651 979.

You can also contact them by email: