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Symptoms
By Mayo Clinic staffA cluster headache strikes quickly, usually without warning. Typical signs and symptoms include:
- Excruciating pain, generally located in or around the eye, but may radiate to other areas of the face, head, neck and shoulders
- One-sided pain
- Restlessness
- Excessive tearing
- Redness in the eye of the affected side
- Stuffy or runny nasal passage in the nostril on the affected side of your face
- Sweaty, pale skin (pallor) on the face
- Swelling around the eye on the affected side of your face
- Reduced pupil size
- Drooping eyelid
The pain of a cluster headache is often described as sharp, penetrating or burning. People with this condition say that the pain feels like a hot poker being stuck in the eye or that the eye is being pushed out of its socket. People with cluster headache appear restless, preferring to pace or sit and rock back and forth to soothe the attack. In contrast to people with migraine, people with cluster headache usually avoid lying down during an attack because this position seems to increase the pain.
Some migraine-like symptoms, including nausea, sensitivity to light and sound, and aura, may occur with a cluster headache.
Cluster period characteristics
A cluster period generally lasts from one to 12 weeks. The starting date and the duration of each cluster period may be consistent from period to period. For example, cluster periods occur seasonally, such as every spring or every fall.
Most people have episodic cluster headaches, which means the cluster headaches occur for one week to a year, followed by a pain-free remission period that may last as long as six to 12 months before another cluster headache develops. Chronic cluster periods may continue for more than a year, or pain-free periods may last less than one month.
During a cluster period:
- Headaches typically occur every day, sometimes several times a day.
- A single attack may last from 15 minutes to three hours.
- The attacks happen often at the same time within each 24-hour day.
- The majority of attacks occur between 9 p.m. and 9 a.m.
The pain usually ends as suddenly as it begins, with rapidly decreasing intensity. After attacks, most people are completely free from pain but exhausted.
When to see a doctor
If you've just started to experience cluster headaches, see your doctor to rule out other disorders and to find the most effective treatment. Headache pain, even when severe, usually isn't the result of an underlying disease, but headaches may occasionally indicate a serious underlying medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm). Additionally, if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
See your doctor or go to the emergency room immediately if you have any of these signs and symptoms:
- Abrupt, severe headache, often like a thunderclap
- Headache with a fever, stiff neck, mental confusion, seizures, numbness or speaking difficulties, which may indicate a number of problems, including stroke, meningitis, encephalitis or brain tumor
- Headache after a head injury, even if it's a minor fall or bump, especially if it gets worse
- A sudden, severe headache unlike any other headache you've experienced.
- Bajwa ZH, et al. Patient information: Headache causes and diagnosis in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 19, 2008.
- Goetz CG. Headache. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/115317111-2/787037600/1488/451.html. Accessed Dec. 29, 2008.
- Leroux E, et al. Cluster headache. Orphanet Journal of Rare Diseases. 2008;3:20.
- Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm?css=print. Accessed Dec. 29, 2008.
- Bajwa ZH, et al. Approach to the patient with headache syndromes other than migraine. http://www.uptodate.com/home/index.html. Accessed Dec. 19, 2008.
- Treatment of primary headache: Cluster headache. National Guideline Clearinghouse. http://www.guideline.gov/summary/summary.aspx?doc_id=6582&nbr=004142&string=clus. Accessed Jan. 2, 2009.
- Bajwa ZH, et al. Patient information: Headache treatment in adults. http://www.uptodate.com/home/index.html. Accessed Dec. 19, 2008.
- Magis D, et al. Neurostimulation in Chronic Cluster Headache. Current Pain and Headache Reports. 2008;12:145.
- Rossi P, et al. Use of complementary and alternative medicine by patients with cluster headache: Results of a multi-centre headache clinic survey. Complementary Therapies in Medicine 2008;16:220.
- Swanson JW (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 12, 2009.
