Cluster Headache


What Is It?

Cluster headaches are very intense headaches that typically center around one eye, then spread to nearby areas of the face. In general, each headache lasts about a half-hour to three hours, but episodes can occur several times during the same day or night (in clusters) for several weeks or months. On average, there are one to three headache episodes daily during a four- to eight-week period. However, once this cluster of episodes ends, the patient may remain headache-free for months or years. Although the exact mechanism behind cluster headaches remains a mystery, researchers believe that these headaches may be related to abnormal cell activity in a region of the brain known as the hypothalamus.

Approximately 1 million people in the United States have cluster headaches, and the condition is seven to eight times more common in men than in women. The first cluster episode usually occurs sometime between ages 20 and 50. About 80 percent of cluster headaches occur at night, and in about 70 percent of patients, a cluster headache can be triggered by drinking alcohol.


Symptoms of cluster headache include:

  • Intense pain that is localized around one eye or sometimes near the temple — Pain is deep and explosive, usually builds to maximum intensity within five minutes, and can spread to nearby areas of the cheek or jaw.
  • A bloodshot or tearing eye on the affected side
  • Smaller pupil or droopy eyelid on the affected side
  • Runny nose or blocked nostril on the affected side
  • Facial flushing
  • Nausea

Many cluster sufferers feel better when they remain active during their headaches. This is in contrast to those experiencing migraine headaches, who tend to seek out a quiet, dark room.


Your doctor will ask about your medical history and your specific headache symptoms to determine whether your headaches are cluster-type or if they might be related to an underlying disease. He or she also will examine you to check for other possible causes of your headaches. If your examination is normal and your headaches fit the typical cluster pattern, you may not need any further testing. However, your doctor may order additional tests to rule out more worrisome causes of your symptoms. These tests could include Computed tomography (CT) or magnetic resonance imaging (MRI) scans.

Expected Duration

Cluster headaches usually last a half-hour to three hours, one to three times daily for four to eight weeks. Once this cluster of episodes passes, it is not unusual for a person to remain headache-free for months or sometimes years. The average person who gets cluster headaches experiences at least one episode of headaches each year.


Since the mechanism behind cluster headaches remains a mystery, there is no way to prevent a first occurrence. However, patients who have already experienced cluster headaches can reduce the likelihood of future attacks if they avoid alcohol, quit smoking and maintain a regular sleep pattern.


It is difficult to stop the pain of a cluster headache that is in progress, since the headache usually disappears by the time the patient reaches the doctor’s office or emergency room. Treatment is usually focused on preventive therapy to decrease the severity and frequency of headaches and to shorten the length of the active cluster period. Lithium (Lithobid and others) and verapamil (Isoptin, Calan) are the two drugs that are most effective at accomplishing this. Other drugs used for this purpose include prednisone (Deltasone and others), cyproheptadine (Periactin) and methysergide (Sansert).

Inhaling 100-percent oxygen for about 15 minutes through a facemask has proven to be helpful when it is done at the first signs of an attack. This oxygen must be prescribed by a doctor and obtained through a medical supplier. Other types of drugs that may be effective when used at the outset of cluster pain include the triptans (Imitrex, Maxalt, Zomig, Axert, Amerge and others), ergotamine (Cafergot), and indomethacin (Indocin).

When To Call A Professional

If any form of headache occurs on a regular basis or begins to interfere with your daily activities, see your doctor


Medical treatment of cluster headaches can help to control pain and shorten active periods, but currently no permanent cure is available. With the right medication, long-term remission of active cluster periods is possible.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.