Cluster headache

7-minute read

If you have a sudden, severe headache or if your headache is accompanied by vomiting, confusion, neck stiffness or changes in your vision, call triple zero (000) and ask for an ambulance or go to your local hospital emergency department.

Key facts

Cluster headaches are a rare but very painful type of headache, that occur very frequently, and for several weeks at a time.
They cause severe pain around one eye, with a runny nose, a red weepy eye and swollen eyelid on the same side of the face.
There is no test for cluster headaches, but you might need to have some tests to rule out other types of headaches.
During a cluster of attacks, headaches can be triggered by alcohol, strong smells or certain foods.
Cluster headaches can be relieved with oxygen and medicines, while different medicines can be used to prevent them from starting.

What are cluster headaches?

Cluster headaches are a rare but very painful type of headache, in which headaches occur in groups, or clusters. They are more common in males and usually start at age 20 to 40 years.

People who get them find they have frequent headaches over a few weeks, then none for a while. This is called 'episodic cluster headache'.

During a cluster, headaches can occur up to 8 times a day. They often start at night or early in the morning and can wake you up from sleep. These clusters often occur at the same time each year.

In a few people, the headaches come on continuously without long breaks. This is called 'chronic cluster headache'.

Cluster headaches are very unpleasant, but not dangerous. They may occur less often as you get older.

What are the symptoms of cluster headaches?

The pain of cluster headaches can be very severe. The headaches occur on one side of your face, with sharp pain around or behind your eye. They may go away after 15 minutes or may last up to 3 hours.

You may also experience other symptoms on the same side of your face, such as:

a red and weepy eye
a drooping or swollen eyelid
a runny or blocked nose
sweaty skin

You might also feel restless or agitated.

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What causes cluster headaches?

Doctors don't know what causes cluster headaches. People who smoke have a greater risk of chronic cluster headaches.

Cluster headaches sometimes run in families.

Headaches may be triggered by:

alcohol
foods that contain nitrates — for example, meat, garlic or dark chocolate
strong smells
some medicines, such as nitroglycerin (which is used to treat chest pain)

When should I see my doctor?

If you think you may have cluster headaches, it's important to see your doctor so they can confirm it and help you find the best treatment for it.

If you already have a diagnosis of cluster headache, see your doctor again if your headaches start to feel different or become more severe.

In some cases, headaches can be a symptom of something more serious. See your doctor straight away if you experience:

a severe headache that comes on suddenly
a headache that gets progressively worse over the course of several weeks
a morning headache with nausea that doesn't go away
a headache that starts following an injury to your head

You should also see your doctor straight away if you have a headache accompanied by:

fever
vomiting
neck stiffness
confusion or a change in personality
blurred or double vision
loss of balance
a seizure

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How are cluster headaches diagnosed?

Your doctor will talk to you and examine you. There is no specific test for a cluster headache, but your doctor may do tests to rule out other causes of headache.

Diagnosing and treating cluster headaches can be complex, so your doctor may refer you to a neurologist.

How are cluster headaches treated?

There are treatments that work quickly to treat a cluster headache when it starts. There are different treatments that may help prevent a cluster starting. Your doctor will talk to you about which treatments are appropriate for you.

When you have a cluster headache, your pain may be relieved by:

medicines called triptans — usually given by subcutaneous injection
breathing oxygen through a mask for 15 minutes

Treatments that can prevent a cluster starting may include:

medicines such as verapamil or lithium
neuromodulation, which involves using an electrical signal to stimulate nerves in your brain

Can cluster headaches be prevented?

There's no known way to prevent yourself developing cluster headaches, but it's best to avoid smoking, which can increase your risk. Knowing your triggers and avoiding them may be helpful, even while you are in the middle of a cluster of headaches.

If you have been diagnosed with cluster headache, there are a number of treatments that can prevent clusters from occurring. Talk to your doctor about which one is best for you.

If you are in the middle of a cluster, you can reduce your chances of having a headache by avoiding any triggers, such as alcohol, nitrate-containing foods, and strong odours.

Resources and support

Visit Migraine & Headache Australia to learn more about headache and to join an online support group.

Check out the ANZ Headache Society for helpful tips and a list of doctors who specialise in treating headache.

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Last reviewed: June 2023

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