A cluster headache is different from both tension-type headaches and migraine. With this type of headache, you experience pain on one side of your head that can last anywhere from 15 minutes up to three hours, then it starts all over again, up to about eight times a day.
The pain occurs daily for weeks to months, most commonly popping up at the same time every day. The entire cycle — eight times a day for weeks or months — is called an attack. After such an attack, the pain goes suddenly into remission, and it may be months or even years before you experience another cluster.
However, about 1 in 5 people with cluster headaches have a chronic form and may never experience a remission.
Cluster headaches aren’t common, only affecting about 1 out of every 100,000 people.
Symptoms of cluster headaches
Symptoms of cluster headaches other than pain happen on the same side as the pain and include:
- Watery eye
Red eye
Droopy eyelid
Runny or stuffy nostril
Flushing or sweating
The location of your head pain can vary, but it shows up in one of the following regions:
- Orbital: behind your eye or near your temple
Supraorbital: above your eye, near your forehead
Temporal: side of your head behind your ear
When symptoms set in, it usually only takes five to 10 minutes for them to reach their worst.
Many people report that these excruciating headaches wake them up one or two hours after going to bed, and they feel more severe than those during the day. Because of the timing, they’re sometimes called “alarm clock headaches.”
Perhaps more appropriately, they’re often called “suicide headaches” because the pain is so severe and unrelenting people feel like dying must be better. If you or someone you know is feeling this way, call the Suicide and Crisis Hotline (in the US) at 988.
Causes of cluster headaches
Researchers don’t know the exact cause of cluster headaches, but studies have shown that they could relate to your body releasing either histamine (a chemical involved in allergy response) or serotonin (a neurotransmitter) near the trigeminal nerve that sends sensations between your face and brain.
In addition, studies indicate that cluster headaches may happen if there’s dysfunction in the hypothalamus, the region of your brain responsible for keeping your body in a steady state and setting your internal clock to respond to the amount of sunlight you receive. The hypothalamus connection may, for many people, explain the link between the start of headaches and the change of seasons, periods when the amount of sunlight changes along with the weather.
Studies are ongoing to pin down the underlying cause more precisely.
Cluster headache triggers
Triggers are things that causes your symptoms to start, even if you’ve been in remission for a while. Specific triggers during a cluster headache cycle vary from one individual to the next but may include:
- Tobacco, alcohol, and other substance use
Bright lights
Hot temperatures
Nitrites in food (preserved meats)
Certain medications (like sildenafil)
Triggers can also launch a new cycle of attacks after a period of no symptoms.
Diagnosing and treating cluster headaches
Much like migraine, cluster headaches are usually diagnosed by a neurologist or headache specialist after performing physical and neurological exams and combining the information with imaging results. It helps if you see the doctor while you’re in an attack cycle, so they can see the signs and symptoms in real time and understand how they affect you.
There are two types of medications that your doctor might recommend:
Prevention medications
Some medications can shorten a headache cycle and make each of the headaches less severe. The most common ones include those that treat allergies, depression, blood pressure, and seizures. Also, Emgality® is not only an FDA-approved preventive therapy for migraine, but it’s also been approved for cluster headaches. It’s a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), a known player in the pain cascade.
Pain management medications
When a headache occurs, you may experience other symptoms along with the pain; pain management drugs, like triptan medicines (the injectable form of sumatriptan), anti-inflammatory medicines (steroids like prednisone), or dihydroergotamine injections (can’t be taken with sumatriptan), can deal with these along with the pain.
Some people find relief by breathing in 100% oxygen during an attack.
According to Dr. Joanna Kempner at the 2025 Migraine World Summit, low-dose psilocybin (the active ingredient in “magic mushrooms,”) may also be helpful, but because of its Schedule I classification, there’s been little scientific research on the topic.
Generic, over-the-counter anti-inflammatory medications (NSAIDs like ibuprofen) aren’t effective in treating cluster headaches.
Other therapies
If medications don’t help your symptoms, your doctor might suggest surgery to implant a neurostimulator device. It sends electrical signals to specific nerves in your head to manage the symptoms they control.
Some alternative therapies may provide relief from cluster headaches, including:
- Acupuncture: places ultrathin, sterile needles into your skin at various points to relieve pain, nausea, and other symptoms
Physiotherapy: focuses on stretching, moving joints, and massaging techniques
Spinal manipulation: realigns your spine with a chiropractic adjustment
gammaCore: stimulates the vagus nerve externally with use of a neuromodulator
Your doctor may make additional recommendations based on your unique situation.
Leave a Reply