Cluster Headaches: Causes, Symptoms & Treatment

By Chris Bodle, MD
Medically reviewed checkmarkMedically reviewed
September 13, 2021

If you suffer from pain in your head, face, or neck, you are not alone.

Headache disorders—including migraines, tension headaches, medication-overuse headaches, and cluster headaches—are some of the most common ailments of the nervous system.

They affect nearly half of the world’s adult population every year. Although all headache disorders can be painful and debilitating, each type affects people differently.

Cluster headaches are a painful condition in which patients experience severe headaches in cycles, or “clusters”, followed by pain-free remission periods.

The headaches can occur up to eight times a day, and cycles can last weeks or months before pain-free periods begin.

Cluster headaches are considered one of the most painful of all primary headache disorders, though the condition is fairly rare, affecting fewer than one in 1,000 adults worldwide.

Although cluster headache symptoms are extremely uncomfortable, they are not life-threatening and can be treated.

Patients on a proper cluster headache treatment plan often find their pain and cluster frequency significantly reduced

What Is a Cluster Headache?

Cluster headaches are clusters of painful headaches, followed by pain-free periods.

These headaches are generally characterized by severe pain that is localized on one side of the head or around one eye, though pain may radiate to other areas of the face, head, neck, and shoulders.

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There are two types of cluster headaches:

  • Episodic: These headaches occur regularly for less than a year, and are followed by a headache-free period of one month or longer.

Most often, cluster headaches happen after you’ve fallen asleep.

A minority of patients develop cluster headaches during their waking hours.

For most, cluster headaches begin without any warning, though a small percentage experience visual disturbances like flashing lights and auras before the onset of any pain.

Migraine vs. cluster headache

While they share some similar symptoms, migraines and cluster headaches are different types of headaches.

They vary in several ways, including how long symptoms last, how often they occur, and which part of the head they affect. 

Cluster headache attacks begin suddenly and become severe within 5-10 minutes. The pain lasts up to two hours at a time.

On the other hand, migraines can last for an entire day or several days. Migraine pain can also vary in location, while cluster headache pain tends to concentrate at the temple or around the eye. 

Another marked difference between cluster headaches and migraines is that people with migraines will lie down to counteract their pain, while those with cluster headaches will pace or rock back and forth.

Cluster Headache Symptoms

The pain associated with cluster headaches is described as constant, severe, piercing, and burning, and it is often so intense that you may not be able to stay still. 

If you’re experiencing cluster headaches, you may also experience the following physical symptoms:

  • Eye symptoms: A droopy eyelid, constricted pupil, or excessive tearing or redness in the eye.
  • Vision challenges: In addition to potential eye symptoms, you may also experience sensitivity to light.
  • Facial discomfort: Swelling under one or both eyes, nasal congestion or runny nose, and facial flush or pale skin are common cluster headache symptoms.
  • Bodily discomfort: Nausea, restlessness, and extreme agitation are commonly associated with cluster headaches.

What Causes Cluster Headaches?

Cluster headaches occur when the blood vessels that carry blood to your head and face dilate, in turn putting pressure on your trigeminal nerve, which sends pain signals to your brain.

If you experience cluster headaches, some research suggests you may have abnormalities in your hypothalamus, the area of your brain that regulates sleep, body temperature, and hormones.

In other cases, your cluster headaches may be a result of sudden releases of chemicals in your brain, including histamine—a chemical associated with allergies—or serotonin—a neurotransmitter that regulates mood.

Unlike tension headaches and migraines, cluster headaches do not appear to be triggered by your behavior, though you should avoid drinking alcohol and being around strong chemical smells while you’re experiencing a cluster

Diagnosis of Cluster Headaches

When diagnosing your headache disorder, your doctor will make careful note of when, where, and how often you have attacks.

Cluster headaches are characterized by the frequency and length with which they cycle.

You should be prepared to give your doctor a detailed description of your pain in order to get an accurate diagnosis. It is recommended to keep a journal diary of your headaches to discuss with your doctor.

After talking with you about your symptoms, your doctor may use other diagnostic approaches to identify whether or not you suffer from cluster headaches.

You may be asked to undergo a basic neurological examination to test the function of your brain and nervous system.

During the exam, your doctor may use instruments like a light and reflex hammer to check your motor skills, reflexes, senses, balance, coordination, and nerve function.

Most exams are short and routine, and should not cause you any discomfort or pain.

If your doctor believes that further tests are warranted, they may order imaging tests to rule out other underlying conditions that might be causing you pain.

The imaging tests they order may include:

  • Magnetic resonance imaging (MRI) scans: An MRI is a non-invasive and painless technique that uses magnet radio waves and computer imaging to create a detailed image of your internal organs and tissues.
  • Computed tomography (CT) scans: A CT scan is a painless imaging procedure that takes multiple x-ray images from different angles and, using computer processing, stitches them together into a detailed image.

Cluster Headache Treatment

Although there is no cure for cluster headaches, many patients find relief using a variety of medical treatments and techniques to treat and prevent their pain.

Because attacks come on suddenly, fast-acting pain medications and other therapies are important in alleviating pain.

Successful treatment of cluster headaches may include the following:

Therapies and remedies

  • High-flow oxygen therapy: You may find significant relief with high-flow oxygen therapy, which involves breathing in 100% pure oxygen through a face mask.
  • Cold therapy and other home remedies: Cold water or cold packs applied to the pain location may alleviate symptoms. Additionally, ginger tea, deep breathing exercises, a regular sleep schedule, and over-the-counter supplements such as magnesium, kudzu, vitamin B-2, and melatonin may help you manage your symptoms.


  • Triptans: The same tryptamine-based medications that constrict blood vessels to treat migraines can help those who suffer from cluster headaches. Because cluster headaches develop suddenly, medications must either be injected or taken as a nasal spray to work as quickly as possible. Though triptans have few side effects, they can exacerbate heart conditions and should not be taken if you are pregnant or breastfeeding.
  • Octreotide (Sandostatin): This injectable medication that mimics somatostatin (a naturally produced chemical that slows the release of hormones like serotonin) also works by constricting blood vessels. Although drug trials have shown that the medication is an effective treatment for cluster headaches, it’s considered less effective than triptans and is usually only prescribed as a secondary option.
  • Dihydroergotamine (DHE): This injectable medication may help relieve pain within five minutes. DHE is considered a safe and effective way to control cluster headaches, though it should not be used in conjunction with sumatriptan.
  • Intranasal anesthetics (numbing medications): Medications like lidocaine have been studied as possible treatment options for cluster headache pain.

Preventive medications

Preventive medications are used when a patient is in cycle and reduced once the cycle ends.

Preventive treatment medications include: 

  • Verapamil (Calan, Isoptin): This medication used to treat high blood pressure has also proven to effectively treat episodic cluster headaches when taken daily. 
  • Topiramate: This anti-seizure medication can effectively treat both episodic and chronic cluster headaches. 
  • Valproic acid: Used to treat both episodic and chronic cluster headaches, valproic acid is thought to be more effective for people who experience migraine-type symptoms, such as nausea, vomiting, photophobia, and phonophobia, with their cluster headaches.
  • Lithium carbonate: Often used to treat bipolar disorder, lithium carbonate may effectively treat chronic cluster headaches. Although it’s unclear why the medication works as well as it does, some scientists believe it’s because it impacts REM sleep, the sleep stage when most people develop headaches. Others suggest that it beneficially affects serotonin and histamine levels.
  • Corticosteroids: Inflammation-suppressing corticosteroids like prednisone are highly effective at treating cluster headaches that occur in short bursts with long remission periods in between. They can be a great short-term option but can carry more significant risks, including hypertension, cataracts, and diabetes if they are taken for a long period of time.

Occipital nerve block

The greater occipital nerve transmits feelings of pain in the top and back of the head and appears to play a role in cluster headaches.

An occipital nerve block involves injecting pain-relieving medication and steroids into the back of the head near the nerve. This procedure may help manage pain from cluster headaches as well as migraines. 


If you don’t respond well to medications or other noninvasive therapies, your doctor may suggest surgery to  implant an electrode or neurostimulator in your brain.

This implant promotes nerve stimulation in the occipital nerve or the nerve cells that are linked to the trigeminal nerve where cluster headaches form.

Researchers are continually exploring new treatment options for cluster headaches.

For example, the Federal Drug Administration (FDA) approved a noninvasive neuromodulation device called gammaCORE, which applies mild electrical pulses to your vagal nerve at the base of your neck.

Other therapies, including an electrical stimulator implanted in your gums and an injectable antibody-based treatment, are currently in clinical trials.

Prevention Tips

A healthcare provider can recommend specific headache prevention measures based on the regularity and duration of your cluster headaches and whether they are chronic or episodic in nature.

Potential preventative treatments include:

  • Lifestyle changes: Maintaining a regular sleep schedule and reducing or completely avoiding alcohol consumption may help prevent cluster headaches during a cluster period.
  • Breathing exercises: While breathing exercises have not been proven to prevent cluster headaches, some healthcare professionals recommend trying them. Techniques include deep, rhythmic, and visualized breathing. 
  • Avoiding triggers: Certain things can induce cluster headaches. Although everyone is different, common cluster headache triggers to try to avoid include smoking, alcohol consumption, and strong smelling chemicals such as perfume, paint, and gasoline. 

Risk Factors and Complications

Cluster headaches are rare, affecting less than one in 1,000 people.

However, a few risk factors may make you more susceptible to developing the condition.

This includes:

  • Sex: Men are 5-6% more likely to develop cluster headaches than women.
  • Smoking: The majority of cluster headache sufferers are heavy smokers.
  • Age: Cluster headaches usually develop in people who are between 20-40 years old.
  • Genetic predisposition: People with a family history of cluster headache are more likely to develop it themselves.

Cluster headaches are not life-threatening and do not cause brain damage.

The attacks, however, can be intensely painful and sometimes debilitating, and the experience of that pain can significantly impair your overall well-being.

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When to See a Doctor

If you are experiencing intensely painful headaches that are unexplainable, occur regularly, wake you up in the middle of the night, or feel localized around a specific area of your face or eye, it’s time to make an appointment with your doctor.

Before your appointment, try to keep a headache diary that includes:

  • The date of each headache
  • The duration and intensity of the pain
  • Any possible triggers
  • Symptoms you experienced before, during, or after the headache
  • Medications and supplements you are taking
  • Any remedies that provided you pain relief

Providing as much information to your doctor as you can will help them pinpoint the cause of your pain and recommend the best treatment options for you.

Occasionally a headache can signal a medical condition that requires emergency care.

If you are experiencing any of the following, call 911 or visit your nearest emergency room:

  • A headache that comes on explosively, violently, or “feels like a thunderclap”
  • A headache that develops after weightlifting, aerobics, jogging, sexual activities, or a head injury
  • A headache that is accompanied by slurred speech, memory loss or confusion, a change in vision, difficulty moving arms or legs, or loss of balance
  • A headache that is accompanied by vision problems, pain when chewing, weight loss, fever, stiff neck, or nausea
  • A headache that gets progressively worse over 24 hours
  • A headache that is your first ever, your “worst ever”, or if you are over 50 and have just started getting headaches
  • A new headache and you have a history of cancer
  • A new headache and you are immunocompromised by diseases such as  HIV or medications that weaken your immune system like chemotherapy drugs and steroids

How K Health Can Help

Cluster headaches may be painful but they are treatable with the right healthcare team.

Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and, if needed, text with a clinician in minutes. K Health’s AI-powered app is based on 20 years of clinical data.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Chris Bodle, MD

Dr. Bodle is a board certified emergency medicine physician. He received his medical degree from Indiana University School of Medicine, and completed his residency in emergency medicine at Emory University. In addition to K Health, he currently works as an Emergency Medicine physician in an Urban, Level 1 Trauma Center in the south east.

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