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Signs and Symptoms of Cluster Headache

While sometimes confused with migraine disease, cluster headache is not a type of migraine and has its own set of signs and symptoms. Cluster headache is a primary headache disorder and is a part of the trigeminal autonomic cephalgias (TAC) group.1,2 This means they develop on one side of the head in the trigeminal nerve area and symptoms that develop are in the autonomic controlled systems on the same side of the head as the headache. Although there are some similarities to migraine, cluster headache is not the same.1

What is a cluster headache?

Cluster headache attacks occur in episodes. They are characterized by periods of daily, painful head pain that most often start at night, usually within a few hours of going to sleep. They typically occur at the same time each day with intense pain coming on quickly and stopping as suddenly as it starts. When these attacks end, people with cluster feel exhausted but without ongoing symptoms.1

Who gets cluster headache?

Men develop cluster headache more often than women. They generally develop between the ages of 20 and 40. A family history of cluster headache or being a smoker can increase risk of developing them. There is not a lot of research in this area so there is little to more clearly define the genetic association or even an accurate diagnostic count of people who have had to live with them. Cluster headache is underdiagnosed and often misdiagnosed, according to Eileen Brewer of ClusterBusters, a non-profit cluster headache research and educational organization.1,2

Symptoms of cluster headache

Some people may experience the nausea and auras generally attributable to migraine before the pain from the cluster headache, which comes on rapidly. Common symptoms include:1,2

  • Restlessness
  • Pain behind or around one eye
  • One-sided pain that can radiate to face, head and neck
  • Tearing, or eye redness on the affected side
  • Droopy eye lid on the affected side
  • Swelling around the eye on the affected side
  • Stuffy or runny nose on the affected side
  • Pale skin or flushing on the affected side
  • Facial swelling on the affected side

The pain can be so intense that people experiencing cluster headache are likely to rock back and forth or pace to try and block it out. They can become restless and agitated.2 People with migraine, by contrast, are more likely interested in lying down in a quiet, dark room to ease their pain.

Cluster triggers

There is no one cause for cluster headache. Some research indicates that abnormalities in the hypothalamus area of the brain that controls the biological clock can bring about cluster headache.1 Typical migraine disease has specific triggers. Yet, once a cluster headache comes on, many people refrain from drinking alcohol as this can make some cluster headache attacks worse. There are also certain medications that may trigger cluster headache including nitroglycerine, taken for heart problems.1

Cluster periods

Cluster periods can last a year or longer. Then, without warning they can go into remission, disappearing for months or even years.1 Head pain during the cluster period occur daily, even multiple times a day. They can last for as little as 15 minutes or go on for several hours. When the cluster period ends head pain may not reappear for months or even up to a year. This is why they are called clusters, occurring in groups, lasting for a period of time, then going away and returning unexpectedly.

When to see a doctor

A physician, often a specialist like a neurologist, is best able to diagnose cluster headache. They will evaluate your medical history and likely ask you to keep a headache diary as part of the evaluation. It is important to contact your doctor if you think you have developed cluster headache or experience a significant change in the pain or pattern of headaches.1

  1. Cluster Headaches. Available at: https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080. Accessed 6.8.19
  2. Understanding Cluster Headache. Available at: https://americanmigrainefoundation.org/resource-library/cluster-headache-2/. Accessed 6.8.19

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