Symptoms and Signs of Cluster Headache FAQs

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/4/2021

Doctor's Notes on Cluster Headache FAQs

Cluster headache is an uncommon condition characterized by short-lived attacks of sudden, severe pain that is usually one-sided and occurs in clusters, usually at the same time of day or night for several weeks. Episodic cluster headaches occur in periods (clusters) lasting from one week to one year, separated by headache-free intervals lasting at least two weeks. Chronic cluster headaches occur for more than one year without remission or with remissions lasting less than 2 weeks. 

Symptoms of cluster headaches include intense pain that comes on without warning and peaks around 5 to 10 minutes from when the headache first begins, and then the pain continues at peak intensity for up to three hours. The pain is generally described as excruciating, explosive, deep, and/or piercing (but usually not throbbing), like an ice pick is being driven into the eye. The stabbing eye pain can feel like an electrical shock. Cluster headache pain often begins in the eye and always on one side of the face. Other symptoms of cluster headaches include

  • stuffy and runny nose on the same side as the pain around the eye,
  • watery eyes, increased blood flow to the membranes lining the eyeball and the inside of the lids, facial sweating,
  • eyelid swelling,
  • complete or partial Horner syndrome (a condition causing ptosis [eyelid closure],
  • change in pupil size on one side of the face, and lack of sweating) that may persist between attacks, and
  • fast heartbeat.

What Is the Treatment for a Cluster Headache?

Acute treatment for a cluster headache includes treatments to lessen symptoms and make headache stop (to “abort” the headache). Initial treatment for cluster headaches in a healthcare setting includes:

  • Oxygen therapy: 100% oxygen given by nasal canula
  • Triptan medications: given as a shot subcutaneously or intranasally
  • Ergotamine medications: given intravenously (IV)
  • Anti-nausea medications (antiemetics): given in pills or as shots or as IV

Preventative treatments are available for cluster headaches. Cluster headaches tend to occur in episodic clusters and preventative treatments should be started right away when an episodic cluster starts to keep the episodes and their symptoms to a minimum. Prevention medications and treatments used for cluster headaches include:

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.