Health condition · Clinically reviewed
Cluster headache, the most severe primary headache — modern acute and preventive treatment.
Excruciating strictly-unilateral headaches around the eye with autonomic features. High-flow oxygen and sumatriptan injection abort attacks; verapamil and CGRP antibodies prevent them.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BASH or peer-reviewed sources you can see at the end.
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Updated for 2026
Reflects current UK practice including CGRP monoclonal antibodies for episodic cluster headache.
Key facts
Cluster headache at a glance.
The essentials, in plain English — what it is, who gets it, the acute drugs that work fast, and the modern preventives that keep bouts short.
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What it is
A severe unilateral orbital or temporal headache with prominent autonomic features on the same side.
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Episodic or chronic
Episodic cluster headache runs in bouts (weeks to months) with pain-free remissions; chronic runs continuously.
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Who gets it
Male predominance — roughly three to four times more common in men than women.
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Circadian pattern
Attacks often occur at the same time each day and frequently wake people from sleep.
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Acute treatment
High-flow 100% oxygen at 12-15 L/min is a specific, effective abortive — alongside subcutaneous sumatriptan.
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Prevention
Verapamil (with ECG monitoring) is first line; galcanezumab (a CGRP antibody) is licensed for episodic cluster headache.
Why this guide matters
The right treatment stops attacks in minutes.
Cluster headache is often misdiagnosed as migraine or sinus disease. The three points below shape everything else on this page.
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Oxygen is a specific treatment
High-flow 100% oxygen aborts most cluster attacks within 15-20 minutes and is available on the NHS.
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Injection, not tablets
Cluster attacks peak too fast for oral triptans — sumatriptan injection or nasal zolmitriptan is the acute drug of choice.
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Prevention has caught up
Verapamil remains first line, and galcanezumab has given episodic cluster headache a modern CGRP-based option.
How the diagnosis is made
From first attacks to a clear plan.
The steps a UK GP and neurologist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Spotting the pattern and confirming the diagnosis
Phase 2 · Confirming
Secondary causes excluded and ECG checked before verapamil
Phase 3 · Managing
Specialist plan for acute and preventive treatment
- 01
Recognising
Symptom and timing pattern
Short (15-180 minute) unilateral orbital attacks, 1-8 a day, in clusters — the shape is nearly diagnostic.
- 02
Recognising
Autonomic feature review
Same-side ptosis, lacrimation, conjunctival redness, nasal congestion or rhinorrhoea are actively looked for.
- 03
Recognising
Headache diary
Timing, duration, side, triggers (especially alcohol in bout) and response to treatment are logged for review.
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Confirming
Rule out secondary causes
MRI brain (with pituitary views) excludes lesions that can mimic cluster headache, especially on first presentation.
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Confirming
ECG before verapamil
A baseline ECG is required before starting verapamil and repeated as the dose is titrated up.
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Managing
Neurology consultation
Specialist confirmation, acute plan (oxygen, sumatriptan injection) and prevention are set.
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Managing
Multidisciplinary headache clinic
For refractory cases — nerve blocks, CGRP antibodies and neuromodulation are considered.
Typical timeline: 4-8 weeks from first appointment to a settled plan.
Symptoms
What a cluster attack actually feels like.
Short, ferocious and unmistakable once you know the pattern — restless, one-sided, and always with autonomic signs on the same side.
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Strictly unilateral
Always the same side within a bout — pain does not cross the midline.
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Orbital or periorbital pain
Deep, boring, excruciating pain around or behind one eye or temple.
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Autonomic features
Same-side ptosis, tearing, nasal congestion, sweating or redness of the eye.
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Restless and agitated
People pace and rock during attacks — the opposite of a migraine sufferer who lies still.
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Circadian night-time pattern
Attacks often strike at the same hour, commonly waking from sleep 1-2 hours in.
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Bouts of weeks to months
Episodic form runs in clusters, with remissions of months to years between them.
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Chronic form
Attacks continue for a year or more with remissions shorter than three months.
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Red flag: SNOOP features
New, progressive or focal features — urgent brain imaging is arranged.
Treatment
How cluster headache is treated in the UK.
Fast abortive treatment for individual attacks, and preventive treatment to shorten the bout — what each option does and when it fits.
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High-flow 100% oxygen
12-15 L/min via a non-rebreather mask for 15-20 minutes — a specific, non-drug abortive for cluster attacks.
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Sumatriptan subcutaneous injection
6 mg self-administered — the fastest and most reliable acute drug treatment.
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Nasal zolmitriptan
5 mg intranasal — an alternative when injection is unsuitable or not tolerated.
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Verapamil (prevention)
Titrated up under ECG monitoring — the first-line preventive for both episodic and chronic cluster headache.
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Galcanezumab (CGRP antibody)
A monthly injection licensed for episodic cluster headache to shorten and blunt bouts.
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Short-course prednisolone bridge
A tapering steroid course can break a bout while verapamil is titrated to effect.
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Lithium (chronic CH)
A specialist-supervised option for chronic cluster headache, with regular blood-level monitoring.
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Nerve blocks and neuromodulation
Greater occipital nerve blocks, sphenopalatine ganglion block or occipital nerve stimulation for refractory cases.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or neurologist knows your history and can tell you which parts apply to you. If in doubt, seek assessment — especially with any red-flag features.
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NICE. Headaches in over 12s: diagnosis and management (CG150 / NG150).
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British Association for the Study of Headache (BASH) national guidelines.
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International Headache Society. ICHD-3 diagnostic criteria — cluster headache.
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OUCH UK — Organisation for the Understanding of Cluster Headache.
Red flags
When a headache is not just cluster.
Most cluster patterns are benign in origin. These are the features that need urgent assessment — do not push through them.
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SNOOP features
Systemic symptoms, neurological signs, sudden onset, older age or pattern change — urgent brain imaging.
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Progressive headache
Steadily worsening baseline pain between attacks needs same-day assessment.
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New neurological deficit
Weakness, numbness, visual loss or speech change — call 999 or seek urgent review.
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Post-trauma headache
New headache after a head injury deserves prompt clinical assessment.
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Immunocompromised
HIV, chemotherapy or long-term steroids — a lower threshold for imaging and infection workup.
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Age over 50, new headache
First-ever headache after 50 needs assessment to exclude giant cell arteritis and other causes.
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Pregnancy
New or changing headache in pregnancy — urgent review to exclude pre-eclampsia and venous thrombosis.
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Cardiac contraindications
Ischaemic heart disease or conduction problems can rule out triptans or verapamil — flag before starting.
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Suicidal ideation from pain
Cluster headache is known as the “suicide headache” — mention any such thoughts urgently.
Living with it
A brutal condition, but a very treatable one.
Four things that make the biggest difference day to day — the diary, the bout rules, the rescue plan and the community.
A quiet reminder
Speed of treatment is everything.
Oxygen at the first prick of pain and sumatriptan within minutes are what shorten the attack — not what you take an hour later.
- 01 Diary
Track before you treat
A short diary of attacks, timing and response makes every clinic appointment more useful.
- 02 Bout hygiene
Avoid alcohol during bouts
Alcohol reliably triggers attacks in an active bout — abstinence during a cluster helps.
- 03 Rescue plan
Oxygen and sumatriptan, ready
Home oxygen and pre-filled sumatriptan should be within arm’s reach once a bout starts.
- 04 Support
You are not alone
OUCH UK connects patients and families — the community shortens the learning curve.
Frequently asked
Everything we get asked about cluster headache.
Quick answers on oxygen, sumatriptan injection, verapamil, CGRP antibodies and how cluster differs from migraine.
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What is cluster headache?
A primary headache disorder causing brief, excruciating one-sided attacks around the eye or temple, with autonomic features such as tearing, ptosis and nasal congestion on the same side.
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How is it different from migraine?
Cluster attacks are shorter (15-180 minutes), strictly unilateral, come in clusters, and people are typically restless and agitated. Migraine attacks last 4-72 hours and people usually prefer to lie still in the dark.
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Does oxygen really work?
Yes. High-flow 100% oxygen at 12-15 L/min through a non-rebreather mask aborts most attacks within 15-20 minutes and is prescribed on the NHS via a home-oxygen assessment.
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Why sumatriptan injection rather than tablets?
Cluster attacks peak far too quickly for oral triptans to work. The subcutaneous injection or nasal zolmitriptan reach effective levels in minutes.
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What are the CGRP antibodies?
Galcanezumab is a monthly injection that blocks the calcitonin gene-related peptide (CGRP) pathway. It is licensed in the UK for episodic cluster headache to shorten bouts.
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Is cluster headache dangerous?
The pain itself is not life-threatening, but it is severe enough to be called the “suicide headache”. Any thoughts of self-harm should be raised urgently — support, treatment and prevention all help.
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