Cluster Headache
Cluster headache brings short, very painful attacks on one side of the head, most often around or behind one eye. The attacks tend to come in runs, often at the same time of day.
What is cluster headache?
Cluster headache is a primary headache disorder. That means the headache is the condition itself, not a sign of some other illness. It belongs to a small family of headaches called trigeminal autonomic cephalalgias (TACs). These are headaches that cause one-sided head pain along with “autonomic” symptoms, such as a watery eye or runny nose, on the same side.
Cluster headache is often called one of the most painful headache types. People with it rate the pain at the very top of the scale. The National Headache Foundation notes that people compare it to labor pain or a heart attack.
It is more common in men than in women. In one large survey of more than 1,600 people with cluster headache, about 69% were men. It usually starts between ages 20 and 50. Women may be more likely to be misdiagnosed with migraine at first.
Episodic and chronic cluster headache
- Episodic: attacks come every day for a stretch of weeks or months. Then they stop for a pain-free break that can last months or even years. About 8 in 10 people have this type.
- Chronic: attacks keep coming without a real break, or the breaks last less than 3 months.
Some people move between the two patterns over time. About 15% switch from one type to the other.
Common symptoms
- Sudden, severe, stabbing or piercing pain on one side of the head, around or behind the eye, or at the forehead or temple
- Pain that builds quickly, often reaching its peak within a few minutes
- On the same side as the pain: a red or watery eye, a drooping or swollen eyelid, a smaller pupil, a stuffy or runny nose, or a sweaty or swollen face
- Feeling restless or agitated. Many people pace or rock during an attack instead of lying still, which is different from migraine.
- Attacks that arrive like clockwork, sometimes waking you at the same time each night
What causes it, and what can trigger an attack
The exact cause is not known. Experts think attacks begin in the hypothalamus, a part of the brain that also runs your body clock. In about 5% of cases, cluster headache runs in families.
Things that may set off an attack, especially during a cluster period, include:
- Alcohol, which can trigger attacks in 40% to 80% of people with cluster headache
- High altitude, such as air travel or mountain climbing
- Weather changes in temperature or air pressure
- Bright, intense sunlight
The role of tobacco is not clear. Smoking may be a risk factor that makes attacks more frequent and cluster periods longer.
How it is diagnosed
A headache specialist or neurologist makes the diagnosis based on your story: where the pain is, how long attacks last, how often they come, and which symptoms show up with them. Keeping notes on the timing of each attack can help.
The National Headache Foundation recommends an MRI (a detailed scan of the brain) for people with cluster headache symptoms. The scan helps rule out other serious conditions. It suggests seeing a provider if you have sudden, severe attacks, attacks that follow a cycle or come at the same time of day, or one-sided eye tearing, stuffy nose or a drooping eyelid with your headaches.
Treatment options
Most people with cluster headache can be treated. A plan is tailored to each person and often combines three kinds of treatment. Experts stress that every attack should be treated.
Treatments to stop an attack (acute)
- High-flow oxygen breathed through a special mask. The American Migraine Foundation reports it ends about 80% of attacks within 20 minutes.
- Fast-acting triptans, such as sumatriptan given as a shot or nasal spray. Triptan pills are not recommended for stopping these attacks.
- Dihydroergotamine (DHE) given as an injection.
- A handheld vagus nerve stimulator, a prescription device held against the neck at the start of an attack. It is approved for episodic cluster headache.
Short-term “bridge” treatments
These work quickly and may shorten a cluster period while a longer-term preventive starts to work. Examples are a short course of steroid pills, or occipital nerve injections: a numbing medicine plus a steroid injected at the back of the head. The American Migraine Foundation notes the injections often cause fewer side effects than steroid pills.
Preventive treatments
Preventives are taken over a longer time to make attacks less frequent. Examples the sources name include verapamil (a heart and blood pressure medicine that needs heart monitoring), galcanezumab (a CGRP antibody approved for episodic cluster headache), lithium, topiramate and melatonin. The vagus nerve stimulator is also cleared as an add-on preventive. Using one preventive at a time is generally preferred.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience, and she has lived with migraine herself. She treats trigeminal autonomic cephalalgias, including cluster headache.
Every patient starts with a 90-minute new patient consultation with Dr. Park ($520). It includes a full review of your history, a neurological exam, a diagnosis and a personalized treatment plan. The practice focuses on targeted injection treatments, such as an occipital nerve block, rather than a cycle of prescription medications. If appropriate, an injection may be done during your first visit for an added fee. See services and fees.
Appointments are Monday to Friday, 9 a.m. to 6 p.m., usually within days. The practice is direct pay with no referral needed.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- What to Know About Cluster Headache, American Migraine Foundation
- Cluster Headache Treatment Options, American Migraine Foundation
- What Are SUNCT and SUNA?, American Migraine Foundation
- Cluster Headache, National Headache Foundation
- The Complete Headache Chart, National Headache Foundation
Last updated October 27, 2026.
Get a clear plan for cluster headache
Every patient starts with a 90-minute new patient visit with Dr. Park.