What are cluster headaches?

Cluster headaches are extreme headaches that occur in groups, or clusters. They are a rare but painful type of headache. They are more common in males and usually start at age 20 to 40 years.

People who get cluster headaches find they have frequent headaches over a few weeks, then none for a while. This is called 'episodic cluster headache'.

During a cluster, headaches can occur up to 8 times a day and can last for up to 3 hours each. They often start at night or early in the morning and can wake you up from sleep. These clusters often occur at the same time each year.

In a few people, the headaches come on continuously without long breaks. This is called 'chronic cluster headache'.

Cluster headaches are very unpleasant and symptoms can make it hard to do everyday tasks. Cluster headaches are not life-threatening. They may occur less often as you get older.

What symptoms are related to cluster headaches?

The pain of cluster headaches can be very severe, often described as:

• sharp
• burning
• feeling 'like a knife in your eye'

The headaches occur on one side of your face, with sharp pain around or behind your eye. The pain can spread to the forehead, cheeks, nose or gum area. Headaches may go away after 15 minutes or last up to 3 hours.

You may also experience other symptoms on the same side of your face as the pain, such as:

• a red and weepy eye
• a drooping or swollen eyelid
• a runny or blocked nose
• facial sweating

You might also feel restless or agitated.

What causes cluster headaches?

Doctors don't know exactly what causes cluster headaches. People who smoke are more likely to get chronic cluster headaches. People with cluster headaches often report poor sleep quality, especially those with sleep apnoea.

Cluster headaches sometimes run in families and may be linked to your genes.

Headaches may be triggered by:

• alcohol
• foods that contain nitrates — for example, meat, garlic or dark chocolate
• strong smells
• some medicines, such as nitroglycerin (used to treat chest pain)
• high altitudes, for example with air travel
• changes in weather
• stress

How are cluster headaches diagnosed?

Your doctor will talk to you and examine you to diagnose your headaches. There is no specific test for a cluster headache, but your doctor may do tests to rule out other causes of headache. This could include an MRI, CT scan or a lumbar puncture. It can take a long time for doctors to reach a diagnosis of cluster headache.

Diagnosing and treating cluster headaches can be complex, so your doctor may refer you to a neurologist.

When should I see my doctor?

If you think you may have cluster headaches, see your doctor so they can confirm the diagnosis and help you find the best treatment.

If you already have a diagnosis of cluster headache, see your doctor again if your headaches start to feel different or become more severe.

In some cases, headaches can be a symptom of something more serious. See your doctor straight away if you experience a:

• severe headache that comes on suddenly
• headache that gets progressively worse over several weeks
• morning headache with nausea that doesn't go away
• headache that starts after an injury to your head

You should also see your doctor straight away if you have a headache and:

• fever
• vomiting
• neck stiffness
• confusion or a change in personality
• blurred or double vision
• loss of balance
• seizure

How are cluster headaches treated?

A cluster headache can be treated with medicine when it starts. There are also medicines that help prevent a cluster from starting. Your doctor will help you choose the treatment that best suits your situation.

When you have a cluster headache, you can manage your pain with:

• medicines called triptans — sometimes given by injection
• breathing oxygen through a mask for 15 minutes

Treatments that can prevent a cluster starting and reduce the intensity of the headache include:

• medicines such as verapamil or lithium
• neuromodulation (electrical signals to stimulate nerves)

Bridging therapies are treatments used for a short period to help reduce how often you get a cluster headache. These are used in the time between acute treatment and prevention. Bridging medicines include:

• nerve blocks — naratriptan
• corticosteroids — prednisolone or prednisone

What are the complications of cluster headaches?

The complications of cluster headaches are related to how intense the pain can be.

People with cluster headaches often experience:

• depression or anxiety
• difficulty concentrating
• thoughts of suicide

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

Can cluster headaches be prevented?

There's no known way to prevent developing cluster headaches, but it's best to avoid smoking, which increases your chance of having symptoms. Knowing your triggers and avoiding them may be helpful, even while you are in the middle of a cluster of headaches.

If you've been diagnosed with cluster headache, there are medicines that can help prevent clusters from occurring. Talk to your doctor about which one is best for you.

If you are in the middle of a cluster, you can reduce your chances of having a headache by avoiding any triggers, such as nitrate-containing foods and strong odours.

Other things that may prevent cluster headaches include:

• keeping to a regular sleep schedule
• preventing or treating sleep apnoea
• avoiding alcoholic drinks

Resources and support

Visit Migraine & Headache Australia to learn more about headache and to join an online support group.

Check out the ANZ Headache Society for helpful tips and a list of doctors who specialise in treating headache.

For mental health support call one of the following:

• Lifeline provides crisis counselling, support groups and suicide prevention services. Call 13 11 14, text 0477 13 11 14 or chat online.
• Suicide Call Back Service provides support if you or someone you know is feeling suicidal. Call 1300 659 467.

For help quitting smoking or vaping call the Quitline on 13 7848.

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Languages other than English

The Pain Management Network has translated resources in many community languages.

For help quitting smoking, call the Quitline Interpreter Service — if you prefer a language other than English call 13 7848 and ask for interpreter. They will call you back with an interpreter in your language.

Information for Aboriginal and/or Torres Strait Islander peoples

For mental health support, 13YARN has free and confidential crisis support. Call 13 92 76.

Get tips on quitting smoking by calling Quitline for Aboriginal and Torres Strait Islander communities — call 13 7848.