September 4, 2019

5 Things You Should Know About Cluster Headaches

Plus, the new treatment giving hope to those who have them

Woman experiencing a cluster headache

When people think about bad headaches, migraines usually come to mind. But migraine headache pain can’t touch the debilitating, extreme pain that comes with cluster headaches.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“Cluster headaches are extremely rare, affecting only one in 1,000 people,” says headache and facial pain specialist Emad Estemalik, MD. “These severe headaches usually begin before age 30 and sufferers are almost exclusively men.”

Whether or not you’re intimately familiar with cluster attacks, here are five things you should know about cluster headaches:

1. Cluster headaches have very specific features

There are no warning signs that a cluster is about to hit you like a freight train. Even if you’ve experienced one in the past, you can’t anticipate or predict when you’ll get another one. But you’ll know it’s a cluster headache because of the extreme pain (which is why they’re sometimes called suicide headaches). You may also experience these symptoms that occur only on the side of the face that’s experiencing pain:

  • Teary eye.
  • Runny nose.
  • Red eye.
  • Droopy eye.

2. Cyclical and cluster are synonymous when it comes to headaches

Aptly named, these headaches occur in clusters: “Cluster headache cycles may be separated by a period of months or even years,” says Dr. Estemalik. “People enter periods where they have no headaches. But eventually, they rear their ugly heads again.”

Here’s how cluster headache cycles work:

  • A cluster cycle arrives unannounced: It’s like when your least-favorite Aunt, Mildred, shows up without warning during the holidays.
  • The cycle can last weeks to months: How long is Auntie planning to stay? You have no idea, and neither does she.
  • Within each cluster cycle are cluster attacks: Mildred causes painful events throughout the day, like hitting you with her cane when you walk by and repeating passive aggressive comments about your house’s cleanliness.
  • Cycles include up to six attacks each day: Good old Millie, the hits keep coming.
  • Each attack can last 15 to 180 minutes: Three straight days of Aunt Mildred? Please, stop!

3. Prompt treatment is your best defense

The first time you experience a cluster headache, you’ll probably make a beeline to the emergency department to determine the source of your symptoms. Doctors use brain imaging and lab tests to make a correct diagnosis.

“Typically for a cluster cycle, we start with a course of steroids because that can reduce the severity of the attacks and accelerate recovery from the cycle,” explains Dr. Estemalik. “We also start abortive treatments to inhibit future attacks.”

Abortive cluster headache treatments include:

  • Inhaled oxygen.
  • Certain injectable triptan (headache) medications.
  • Procedures such as occipital nerve and Sphenopalatine Ganglion Blocks (SGB).

4. You can prevent cluster headaches from steamrolling you

With subsequent cycles, you’ll want to contact your neurologist or headache specialist to start preventive drugs and abortive treatments when you first experience symptoms. You’ll continue to use the preventive treatments for at least two to three weeks after a cycle ends.

“The goal of preventive drugs is to eliminate the cycle or the recurrence of a cycle,” says Dr. Estemalik. “The goal of abortive treatments is to eliminate the attacks that occur within the cycle, so you don’t have to live with excruciating pain.”


5. Hope is on the horizon

Researchers are exploring new ways to treat cluster cycles. One new treatment is a vagal nerve stimulator. It has been shown to reduce the number of cluster attacks experienced within a cycle. The hand-held device stops the attacks by sending a mild current to the vagus nerve, which sends sensory information to the brain. Patients place the device on their neck for around 90 seconds, two times a day.

“There are a whole lot of negatives when it comes to cluster headaches. But I think the research that’s going into developing treatments that can bring immediate and long-term relief is a huge positive,” says Dr. Estemalik. “There’s definitely reason to be hopeful.”

Related Articles

A vaccine syringe in front of a passport for international travel.
December 5, 2023
Which Vaccines Are Required To Travel?

Plan early — getting the right vaccines can help you stay healthy on your travels

Person overheated lying on chair on the beach; heart rythym next to him
December 5, 2023
How the Heat Can Affect Your Heart

Sizzling temperatures force your heart to work much harder

nocovaine needle entering mouth with dental mirror
December 4, 2023
How Long Does Novocaine Last?

The numbness and tingling should wear off in about two hours

bearded man sitting crosslegged holding clock in one hand, calendar in other
December 4, 2023
Are Bare Minimum Mondays Good for Your Mental Health?

Rethinking your Mondays might make the ‘Sunday scaries’ a thing of the past

A sad couple standing on each side of a large broken heart
December 4, 2023
Yes, You Can Die From a Broken Heart — But No, It’s Not Likely at All

The emotional toll of loss and other strong emotions can have life-threatening physical effects

Closeup of shingles virus presenting on shoulder of person
December 4, 2023
Is the Shingles Vaccine Worthwhile?

It’s 97% effective in preventing shingles in people between the ages of 50 and 69

Notes taped to window of possible new year's resolutions with hand in foreground holding marker.
December 1, 2023
How To Keep Your New Year’s Resolutions

Pick specific, measurable goals, but also be open to changing them if need be

person holding a thermometer with stress thought bubbles above head
December 1, 2023
Yes, There Is Such a Thing as Stress Sickness

From nausea, weight gain and eczema, stress can affect your immune system in many ways

Trending Topics

group of hands holding different beverages
November 14, 2023
10 Myths About Drinking Alcohol You Should Stop Repeating

Coffee won’t cure a hangover and you definitely shouldn’t mix your cocktail with an energy drink

Person applies moisturizer as part of their skin care routine after a shower.
November 10, 2023
Korean Skin Care Routines: What You Need To Know

Focus on the philosophy — replenishing and respecting your skin — not necessarily the steps

glass of cherry juice with cherries on table
November 8, 2023
Sleepy Girl Mocktail: What’s in It and Does It Really Make You Sleep Better?

This social media sleep hack with tart cherry juice and magnesium could be worth a try