Overview

Cluster headache is a very painful type of headache. It usually occurs in periods of frequent attacks known as clusters. Cluster headaches can wake people from sleep. These headaches cause intense pain in or around one eye on one side of the head.

Cluster periods can last from weeks to months. Then usually the headaches stop for a period of time, which may last for months or years.

Cluster headache is rare. Treatments can shorten cluster headache attacks and lessen the pain. Also, medicines can reduce the number of cluster headaches.

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Symptoms

Common symptoms

A cluster headache strikes quickly. There's usually no warning. But some people might first have migraine-like nausea and aura. Common symptoms during a cluster headache include:

Extreme sharp or stabbing pain, usually in, behind or around one eye. The pain can spread to other areas of the face, head and neck.
Pain on one side of the head in a single cluster. Pain can switch to the other side in another cluster.
Restlessness.
A lot of tears.
Redness of the eye on the side that hurts.
Stuffy or runny nose on the side that hurts.
Forehead or facial sweating.
Skin color changes on the side of the face that hurts.
Swelling around the eye on the side that hurts.
Drooping eyelid on the side that hurts.

Because the pain of a cluster headache can be so bad, those who have one are likely to pace or sit and rock back and forth.

Cluster periods

A cluster period usually lasts for several weeks to months. Each cluster period may start at about the same time of year and last about the same length of time. For example, cluster periods can come during certain seasons, such as every spring or every fall.

For most people with cluster headaches, the cluster period lasts from one week to a year. Then there's a pain-free period, known as remission, for three months or longer before the next cluster headache comes. This is known as episodic cluster headache.

Cluster periods might go on for more than a year. Pain-free periods might last less than one month. If a cluster period lasts a year without letup, it's called chronic cluster headache.

During a cluster period:

Headaches usually come every day, often several times a day.
A single attack can last from 15 minutes to three hours, but more often lasts 30 to 45 minutes.
The attacks often occur at the same time each day.
Most attacks occur at night, usually 1 to 2 hours after bedtime.

The pain usually ends as suddenly as it begins. After attacks, most people are pain-free but exhausted.

When to see a doctor

See a health care provider if you've just started to have cluster headaches. Your provider can rule out other illnesses and suggest treatment.

Even bad headache pain isn't usually the result of another disease. But headaches can sometimes mean a serious medical condition. This can include a brain tumor or tear of a weakened blood vessel, known as a dissection.

Also, if you have a history of headaches, see your health care provider if there's a change in how they feel or how often they occur.

Seek emergency care if you have any of these symptoms:

A severe headache that comes on all of a sudden, often like a clap of thunder.
A headache with a fever, nausea or vomiting, a stiff neck, confusion, seizures, numbness, or trouble speaking. These might point to a stroke, meningitis, encephalitis, a brain tumor or other problems.
A headache after a head injury, especially if it gets worse — even if the injury was a minor fall or bump.
A sudden, severe headache unlike any other.
A headache that worsens over days and changes in pattern.

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Causes

Experts don't know what causes cluster headache. Cluster headache patterns suggest a link to the area of the brain that helps run the body's biological clock, known as the hypothalamus.