Cluster headache: symptoms, treatment and causes

The NHS says there is no cure for cluster headaches, but a specialist may recommend treatments that help ease and prevent symptoms. Painkillers such as paracetamol and ibuprofen do not work, so the treatments below are different from usual headache care.

The NHS lists a sharp, burning or piercing pain, usually on one side of the head around the eye, that starts and stops quickly without warning and makes you restless; people often feel they want to walk around or move. Attacks last between 15 minutes and 3 hours and may happen at the same time of year or at set times of day. The Migraine Trust says many attacks come on at night and may wake people at the same time every night, and that the pain usually ends suddenly.

Other symptoms on the same side as the pain can include a red, watering eye, a drooping or swollen eyelid, a smaller pupil, face sweating, and a blocked or runny nose. You may also feel sick.

The NHS says cluster headaches are rare and some of their symptoms can be the same as other conditions, such as migraine. The Migraine Trust points to a useful difference in behaviour: people with cluster headache are agitated and restless, pacing or rocking, while most people with migraine prefer to keep their head still.

The Migraine Trust describes cluster headache as a primary headache, one due to the headache condition itself and not another cause, and as one of the most painful conditions someone can have. It is rare, approximately 1 in 1000 people, more common in men than women, and most commonly starts in the 30s and 40s, though it can affect people at any age.

It can be episodic, with bouts lasting from 7 days to one year separated by pain-free periods of at least 3 months, or chronic, with attacks for more than a year without remission. The Migraine Trust says most cluster periods last between 2 weeks and 3 months, and that up to 2 in 10 people have the chronic form. It tends to get better with age.

The NHS says it is not known what causes cluster headaches. They are more common in men in their 30s and 40s, or if a close family member gets them. The Migraine Trust says they are thought to be linked to the hypothalamus, the part of the brain involved in body temperature, sleep cycles and other functions, and that many people who develop them smoke.

Some people find triggers. The NHS lists smoking, drinking alcohol, perfume, the smell of paint, nail varnish or petrol, and exercise. The Migraine Trust says during a cluster bout many people find alcohol and strong smells can trigger an attack. A headache diary can help you spot patterns.

There is no specific test. The NHS says a GP will ask about the pain, its location and how often it happens, and about other symptoms. Because other conditions can look similar, a GP may refer you to a specialist for a brain scan to rule out other causes.

The Migraine Trust says people are often referred to a neurologist or headache specialist for review and treatment.

See a GP if you think you might have cluster headaches, your headaches keep coming back, painkillers do not help, the pain makes you restless and agitated, or if you have been diagnosed and they are getting worse, lasting longer or your usual treatments are not working.

Get an urgent GP appointment or call NHS 111 for a severe headache with jaw pain when eating, blurred or double vision, a sore scalp, or numbness or weakness in the arms or legs, which could be signs of temporal arteritis (giant cell arteritis).

Call 999 or go to A&E now if you have either of these for the first time, even if you already have a diagnosis: one eyelid drooping or one pupil smaller than the other.

On the NHS the route is a GP and then a neurologist or headache service. Treatments such as oxygen and triptans are prescribed through the NHS. Private neurologists offer assessment and scans with different waiting times and charges; ask what is included. Charities such as The Migraine Trust and OUCH UK provide patient information and support.