Cluster headaches

Cluster headaches cause severe and unbearable unilateral headaches, usually around the eye.

They are called cluster headaches as they come in clusters of attacks and then disappear for a while. For example, a patient may suffer 3 – 4 attacks a day for weeks or months followed by a pain-free period lasting 1-2 years. Attacks last between 15 minutes and 3 hours.

A typical patient with cluster headaches in your exams is a 30 – 50 year-old male smoker. Attacks can be triggered by things like alcohol, strong smells and exercise.



Cluster headaches are often described as one of the most severe and intolerable pains in the world. They are sometimes referred to as “suicide headaches” due to the severity of the pain.

Symptoms are typically all unilateral:

  • Red, swollen and watering eye
  • Pupil constriction (miosis)
  • Eyelid drooping (ptosis)
  • Nasal discharge
  • Facial sweating

Treatment options

Acute management:

  • Triptans (e.g. sumatriptan 6mg injected subcutaneously)
  • High flow 100% oxygen for 15-20 minutes (can be given at home)

Prophylaxis options:

  • Verapamil
  • Lithium
  • Prednisolone (a short course for 2-3 weeks to break the cycle during clusters)


Last updated April 2019