What are the symptoms of cluster headache?
A cluster headache is one-sided, and the pain will typically remain on the same side during the attack cycle.1 The excruciating pain is often described as having a piercing or burning quality. Pain quickly reaches its peak intensity within five to 10 minutes after onset.3 Cluster headache pain is typically located behind or around the eye, around the top side of the head and within the temple and forehead.2
Each cluster headache attack typically lasts between 15 minutes and 1½ hours, but can go on for as long as three hours or more.1 Cluster headache bouts can average about two per day but can occur eight or more times in a single day.3 Most people with cluster headaches experience them in “bouts” of six to eight weeks long, typically in the spring and fall. Some patients have “chronic” cluster headache with no notable relief from attacks.
In addition to the location of the pain, “autonomic” symptoms around the eye, nose and face are often visible.4 During a cluster headache bout, one or more of the following symptoms may occur:
- Reddening and tearing of the eye
- A runny or blocked nostril
- Swollen or drooping eyelid
- Constriction of the pupil
- Flushing and facial sweating
- Restlessness, rocking and pacing
For some patients, the affected eye may become swollen or droop.4 The pupil of the eye may get smaller and the conjunctiva (the tissue that lines the inside of the eyelid) will redden.4 There may be nasal discharge or congestion and tearing of the eye during an attack, which occur on the same side as the pain. About 97% of cluster headache sufferers experience autonomic symptoms.5
In contrast to a migraine sufferer, cluster patients are restless and can become agitated during an attack. Most are unwilling to lay down and prefer to pace about or sit and rock back and forth.6 Exerting pressure on the painful area with a hand or placing an icepack over the painful eye is common.
- Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 3rd ed. Cephalalgia 2013; 33(9) 629–808
- Campbell JL. Facial pain due to migraine and cluster headache. Semin Neurol. 1988;8(4):324-331.
- Robbins, L. (2014, August 7) Cluster Headache. Retrieved from https://www.practicalpainmanagement.com/pain/headache/cluster-headache/cluster-headache
- May, A. Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005; 366: 843–55
- Nappi, G. Accompanying symptoms of cluster attacks: their relevance to the diagnostic criteria. 1992 Jun;12(3):165-8.
- Dodick, et al. Cluster headache. Cephalalgia. 2000 Nov;20(9):787-803.
- Beck, et al. Management of Cluster Headache. Am Fam Physician.2005 Feb 15;71(4):717-724.