Cluster headache causes attacks of severe, one-sided pain in or around the eye, often with a watering eye or a blocked nostril on the same side. Attacks last from 15 minutes to 3 hours and come in bouts that can go on for weeks or months. It is not caused by a neck or muscle problem and needs a medical diagnosis, and effective treatments are available through your GP or a headache specialist.
Also known as cluster headaches, trigeminal autonomic cephalalgia
Symptoms
- Severe, sharp or burning pain in or around one eye or temple, always on the same side during a bout
- Attacks lasting 15 minutes to 3 hours, from one every other day up to several a day
- A red or watering eye, a drooping or swollen eyelid, or a runny or blocked nostril on the painful side
- Feeling restless or agitated during an attack, with a need to pace or rock
- Attacks at similar times each day, often waking you a short time after falling asleep
- Bouts lasting weeks or months, with pain-free spells in between
Causes and risk factors
- The cause is not fully understood, but it is linked to the part of the brain that controls the body clock
- Being male, with attacks usually starting between the ages of 20 and 40
- Smoking: most people with cluster headache smoke or used to
- Alcohol, which can set off attacks during a bout
- A family history of cluster headache
- Strong smells such as petrol, paint or perfume, which trigger attacks in some people
What the evidence says helps
- It needs a medical diagnosis. NICE advises that a first bout of cluster headache is discussed with a GP specialist or neurologist, who may consider a brain scan.3
- Ordinary painkillers such as paracetamol and ibuprofen are not recommended for attacks. NICE recommends a triptan given by injection or nasal spray, and high-flow oxygen breathed through a mask.3
- A Cochrane review found some evidence that breathing oxygen is effective for stopping cluster attacks, and it is cheap and safe.4
- Preventive medicines, most often verapamil, can be taken through a bout to reduce the number of attacks. These need specialist advice and heart monitoring.32
- Hands-on treatment and exercise are not recognised treatments for cluster headache. Current treatment centres on medicines, oxygen and, for some people, nerve stimulation.2
Things you can try at home
- Keep a headache diary noting the time, length and any triggers for each attack, and take it to your GP
- Avoid alcohol completely during a bout
- If you smoke, ask your GP or pharmacist for support to stop
- Steer clear of strong-smelling chemicals such as petrol and solvents during a bout
- Keep to regular sleep times where you can
- Keep your prescribed treatment with you so you can use it at the start of an attack
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden, severe headache that reaches its peak within a minute (thunderclap headache): call 999
- Headache with a fever, stiff neck, a rash, confusion or drowsiness: call 999
- Headache with weakness, numbness, slurred speech, a drooping face or loss of vision: call 999
- A new or worsening headache after a head injury: go to A&E or call NHS 111
- Severe pain in one eye with a red eye, blurred vision or seeing haloes around lights: get same-day medical help
- A first attack, or a change in your usual pattern: see your GP urgently
How Apollo can help
Cluster headache is diagnosed and treated medically, so the most useful thing we can do is recognise the pattern and help you reach your GP or a headache specialist quickly. If you come to us with head or face pain, we take a careful history and examine your neck, jaw and nervous system to work out which type of headache fits best. If you also have neck or shoulder pain between bouts, we can help with that alongside your medical care. We do not offer hands-on treatment as a treatment for the cluster attacks themselves.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How is cluster headache different from migraine?
Cluster attacks are shorter, lasting 15 minutes to 3 hours, and are centred on one eye with a watering eye or blocked nostril on the same side. People usually feel restless and pace about, whereas people with migraine tend to want to lie still in a dark room. A GP or headache specialist can confirm which you have.
Can an osteopath treat cluster headache?
No. Cluster headache is treated with prescribed medicines and oxygen, not hands-on treatment. An osteopath can help recognise the pattern, check for neck or jaw problems that cause other types of headache, and point you towards the right medical care.
How long does a bout of cluster headache last?
Bouts commonly last from a few weeks to about three months and often return at a similar time of year, with months or years free of attacks in between. A smaller number of people have chronic cluster headache with little or no break.
References
- Fischera M, Marziniak M, Gralow I, Evers S (2008). The Incidence and Prevalence of Cluster Headache: A Meta-Analysis of Population-Based Studies. Cephalalgia 28:614-618. View source
- May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ (2018). Cluster headache. Nature Reviews Disease Primers 4. View source
- National Institute for Health and Care Excellence (2012, updated 2021). Headaches in over 12s: diagnosis and management. Clinical guideline CG150. View source
- Bennett MH, French C, Schnabel A, Wasiak J, Kranke P, Weibel S (2015). Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database of Systematic Reviews 2016. View source
- (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1-211. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
