Cluster Headaches – Symptoms, Causes, and Treatment

Cluster Headaches occur in cyclic patterns of cluster periods, which means they follow a specific duration or are episodic in nature. Patient may experience either one or several attacks of sharp pain, within a 24 hour period. The headache can be felt on one side of the head, behind or around the eyes, and at the temple, but is most commonly felt in the forehead. Cluster headaches are rare but quite painful.

Symptoms of cluster headaches

Other than a severe headache, the following symptoms are commonly experienced:

  • Watery or Swollen eyes
  • Nasal congestion
  • Nasal discharge
  • Agitated or restless feeling
  • Pressure in head behind eyes
  • Sharp pain in head behind the eye.

Cluster headaches occur in cyclic episodes. Each episode may last for some weeks to months with a period of remission in between.  The initiation and the time each episode lasts may be consistent episode to episode.

Causes of cluster headaches

The exact cause of these headaches is indefinite however there is a clear difference from migraines which suggests that the cause or pathophysiology of the two is different. Functional imaging studies (which are studies of the human brain function based on analysis of data acquired from different brain imaging modalities) suggest that there is a presence of abnormal hypothalamic activity.

What may trigger a cluster headache?

A cluster headache can develop in response to a number of triggers. Some of the most common triggers are mentioned below:

  • Alcohol and smoking
  • Exertion and fatigue
  • Nitrate containing foods
  • Bright lights and loud sounds
  • Strong smells like that of petrol, perfumes, paint, or solvents 
  • Hot climates
  • Air travel or trekking in areas of higher altitudes

Risk factors

  • There is a notably higher incidence in the male population as compared to the female population
  • The age of onset is usually in the third decade of life
  • Increased incidence in smokers
  • Alcohol consumption
  • There is also genetic tendency involved

What is the difference between a Cluster headaches and other headaches?

Cluster headaches is different from other headache types because of its episodic nature. It is commonly experienced at the same time of the day every day or every week or whatever pattern it follows in the particular individual. Other than the headache, a person also experiences other symptoms like the droopy eyelid, watery eye, or runny nose on the affected side of the head. This can affect any part of the head but is more commonly experienced on one side of the head as compared to the other headache types.

Cluster headaches and Migraine

Cluster headaches are also known as migrainous neuralgia. However, their incidence is much less as compared to migraine. In contrast to the behavior of those with migraine, patients are highly agitated during the episode.

Management of cluster headaches


Cluster headache is very often misdiagnosed as any secondary headache due to pain in the neck, jaw, sinuses, or eyes. Properly trained medical staff can diagnose a case of cluster headache. For this, a detailed history of symptoms is required. 

A cluster headache is only properly diagnosed once it has become chronic.

Preventive Treatment:

The main aim of this treatment is suppression of these attacks and the treatment is helpful at the initiation of each cluster episode. The type of medication used for this depends on the duration and regularity of each episode.

  • Calcium channel blocker: Verapamil, is usually the first choice for preventing cluster headaches.
  • Corticosteroids: These are fast-acting preventive medications
  • Topiramate
  • Ergotamine tartrate
  • Lithium carbonate

Medical treatment:

Even though it is a rare condition, patients with cluster headaches often go misdiagnosed and live with these debilitating headaches all their life. They require proper treatment for the headache as well as depression that is associated with the prevailing condition. 

  • For acute attacks:
    • Subcutaneous injections of sumatriptan
    • Inhalation of 100 percent oxygen
    • Octreotide (However it is less effective and the duration of time it takes to cause relief is greater than that of triptans).
    • Local anesthetics like lidocaine
    • Dihydroergotamine helps in the balance of neurotransmitters
  • For chronic attacks:
    • Antidepressants and mood enhancers are suggested
    • Lithium therapy can help patients with severe chronic clusters but that needs monitoring. So, people experiencing pressure in the head, behind the eyes for a long time may have developed chronic cluster headaches and should speak to a doctor as soon as possible and before beginning any kind of treatment
    • Neuromodulation devices like ceflay and gammacore are non-invasive FDA-approved devices. Electrodes of this gadget are placed on the forehead which sends signals to the supraorbital nerve (ceflay) and vagus nerve (gammacore).

Surgical treatment:

  • A botulinum toxin injection can be used to numb the nerve involved
  • Nerve block or nerve decompression surgeries are also carried out to provide relief from the painful headaches
  • Occipital nerve stimulation devices are also inserted, these devices send impulses to the occipital group of nerves 

Lifestyle changes and home remedies

The following steps may provide a person suffering from cluster headaches relief during a cluster period:

  • Cluster periods can begin when there are changes in your normal sleep schedule. During a cluster period, it may be beneficial to follow your usual sleep routine
  • Alcohol consumption, including beer and wine, can quickly trigger a headache during a cluster period. So it is best to avoid them
  • Maintain a headache diary, this helps you keep track of your triggers and you can avoid them in the future
  • Try relaxation techniques like meditation and yoga
  • Get enough sleep, try melatonin supplements if you have insomnia
  • Low magnesium levels also trigger cluster headaches
  • Some other methods like acupuncture, cupping therapy, and physiotherapy can also be helpful


What are cluster headaches?

Cluster headaches occur in cyclical patterns, which means they follow a specific duration or are episodic in nature. You may wake up with headache in front of head (alarm clock headache).

What is the location of pain for cluster headaches?

  • One side of the head (unilateral)
  • Pressure in head behind eyes
  • Around the eye (peri-orbital)
  • At the temple and forehead

What are the common symptoms of cluster headaches?

  • Sharp pain in head behind eyes
  • Watery or swollen eyes
  • Nasal discharge
  • Agitated or restless feelings

What are the home remedies for cluster headaches?

Stick to a regular sleep schedule and avoid alcohol.

Last medically reviewed on June 23, 2021.