Cluster headaches

Cluster headaches are a severe type of headache that affect one side of the head. They typically occur over several weeks in bouts. They are thought to be one of the most painful sensations someone can experience, and can last up to three hours.

  • Caused by overactivity in the brain and triggers such as alcohol
  • Pain can be so severe that it causes agitation and irritability 
  • Treatment focuses on stopping current attacks and preventing future attacks

Our online video consultation service allows you to speak to a GPhC-registered doctor about cluster headaches. Our clinicians are available to consult with between 9.30am and 4.30pm, Monday to Friday.

  • UK prescribers
  • 24 hour delivery
  • Secured payment
Possible causes

Cluster headaches are thought to be caused by overactivity in the hypothalamus section of the brain. The hypothalamus is linked to the body’s hormone (endocrine) system. During a cluster headache attack, the hypothalamus releases neurotransmitters which trigger pain receptors in the nerve cells. This overactivity can also cause a widening of blood vessels on the side of the head which is affected, leading to feelings of pain. 

One of the reasons why the hypothalamus is suspected of being integral in the cause of cluster headaches is because bouts tend to occur at a similar time of year for a person, at similar times of day. The hypothalamus has an effect on our circadian rhythms (which help to regulate when we sleep). 

It’s not clear why some people get them and others don’t, but an association has been made between smoking and acquiring cluster headaches. Sometimes there is no obvious trigger for an attack, but it is possible that drinking alcohol, smelling a strongly perfumed smell, and being in a hot environment can have an effect.

Symptoms of cluster headaches

A cluster headache occurs suddenly on one side of the head. The bouts usually occur over a period of between 6-12 weeks, and often at the same times each year (autumn and spring). Cluster headaches can either be episodic (where a bout may be followed by an extended period of remission) or chronic (occurring more than once a year).

The attacks are most likely to occur at night, and around 10% of people with episodic cluster headaches go on to develop chronic cluster headaches. 

Pain from cluster headaches is excruciating and feels like it is penetrating the skull. It’s usually felt behind the eye, on one side of the head. 

On average, the pain lasts around 30 to 90 minutes, but it can continue for up to 3 hours. Nausea can also accompany a cluster headache attack, along with nasal congestion, swollen eyelids, sweating on the forehead, restlessness and smaller pupils.

Diagnosing a cluster headache

Cluster headaches can normally be diagnosed from a person’s symptom history. There are certain criteria that someone’s description of their condition has to meet in order for it to be considered a cluster headache. Guidelines from the International Headache Society state the following criteria: severe temporal pain lasting up to 180 minutes; occurence of attacks is between one every other day and eight times a day during bouts, and a headache accompanied by at least one of the symptoms described above.

If you think you may be experiencing symptoms of cluster headaches, a doctor may be able to help you. To consult with one of our GMC-registered doctors online about cluster headaches, you can book an appointment via our video consultation service. Where suitable, they can also provide prescriptions, and referral to specialists for treatment. 

Page last reviewed:  02/06/2020
Types of Treatment

Treatment for cluster headaches aims to provide relief during attacks, and lessen the severity of attacks when they occur. A doctor may also address certain lifestyle factors that can trigger and contribute towards cluster headaches.

How is a cluster headache attack treated?

Cluster headaches cannot be treated like other headaches. Painkillers such as ibuprofen are unlikely to work quickly enough to make a difference. 

The recommended treatments for a cluster headache attack are sumatriptan (administered either as an injection or a nasal spray) and oxygen therapy. 

Sumatriptan injections relieve the pain quickly and are effective around 75% of the time. Sumatriptan is a type of triptan, which is more commonly used in the treatment of a migraine. It doesn’t work in the same way as painkillers, as it interferes with a chemical called 5-HT (or serotonin), and helps to reduce the size of enlarged blood vessels around the brain. 

The dose is 6mg for each headache and should not be administered more than twice in 24 hours. It can result in becoming nauseous and dizzy, but these side effects will not usually last long. It is not recommended for people over the age of 65 or for people with heart problems.

As an alternative to an injection for people who are uncomfortable using needles, there is an equivalent sumatriptan nasal spray. It is not however as effective as the injection, and should not be used for chronic cases of cluster headaches.

Oxygen therapy is another alternative treatment if neither versions of sumatriptan are available or effective. It can relieve pain in around 15 minutes, but is less effective than sumatriptan. For people with pulmonary issues, it may not be suitable.

How can a cluster headache be prevented?

There are various medications that can be used to help prevent episodes of cluster headaches. They all have varying levels of effectiveness depending on the individual. 

Verapamil is the first-line long-term treatment for cluster headaches. It’s prescribed as a 40mg dose, taken twice each day. A doctor may increase this depending on how well it works. ECG monitoring is required with verapamil, as it can have an adverse effect on the heart rate.

Other options include:

  • Lithium. This drug is often used to treat bipolar disorder, and is more beneficial for chronic cluster headaches.
  • Melatonin and ergotamine. These treatments can be useful in delaying nocturnal attacks.
  • Corticosteroids. These can help to break the cycle of chronic cluster headaches. 

In any case, your doctor will go through the options with you and help you decide on the most suitable form of treatment.

If you think you may be experiencing cluster headaches, or if you have been diagnosed with cluster headaches in the past and want to speak to someone, our GMC-registered doctors are available to help. Book an appointment any time between 9.30am and 4.30pm, five days a week, and one of our clinicians will connect with you to chat via video link. They may also be able to offer prescriptions for treatment, where appropriate, and referral to specialists if required. 

Page last reviewed:  02/06/2020
Questions and Answers

How long is it normal to have a cluster headache for?

Cluster headaches occur in bouts between 6 to 12 weeks each year on average. Each individual attack can last between a few minutes and three hours. 

Chronic bouts happen more frequently, whereas cluster headaches which are followed by a long period of remission are called episodic bouts.

Is a cluster headache serious?

A cluster headache is a severe condition, and may cause agonising pain. To alleviate the pain and reduce the frequency of the headaches, treatment is usually necessary.

There are however no long-term complications in particular with cluster headaches (despite the potentially excruciating and debilitating pain). 

Can I get treatment for cluster headaches?

Treatment for a cluster headache attack is administered in the form of an intravenous injection, nasal spray, or oxygen.

The injection and nasal spray work by interfering with serotonin in the brain, helping enlarged blood vessels to narrow and allowing the severe pain to be relieved.

How can I prevent a cluster headache?

It’s difficult to completely prevent a cluster headache if someone has been diagnosed with the condition, but there are a few medications available that can extend the remission period.

Verapamil is the most commonly used treatment for preventing cluster headache attacks.

Can I speak to a doctor about headaches online?

If you would like to speak to a doctor online about cluster headaches, you can talk to one of our GPhC-registered clinicians via our video consultation service. Book an appointment between 9.30am-4.30pm, five days a week, and they’ll be able to provide advice on managing symptoms or preventing an attack.

Page last reviewed:  02/06/2020

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