Severe one-sided headaches around the eye?
Cluster headache is a distinct neurological headache disorder that causes extremely severe attacks, usually around one eye and often accompanied by tearing, nasal symptoms or restlessness.
Getting the diagnosis right matters, because cluster headache is managed very differently from migraine and other common headache disorders.
Cluster headache has a very particular pattern.
Severe pain around one eye
Attacks are usually strictly one-sided, commonly centred around the eye, temple or forehead.
Eye or nasal symptoms
The painful side may also develop a watery or red eye, blocked or runny nose, eyelid swelling or facial sweating.
You can't sit still
Unlike many people with migraine who prefer to lie quietly, people experiencing cluster headache commonly feel restless or need to pace during an attack.
Untreated attacks commonly last between 15 minutes and three hours and may occur repeatedly during a cluster period.
The first priority is getting the headache type right.
Cluster headache can sometimes be confused with migraine, sinus problems and other headache disorders. A detailed history of the attacks is therefore extremely important.
- Exactly where the pain occurs
- How long each attack lasts
- How frequently attacks occur
- Whether attacks occur at similar times of day or night
- Eye, nasal or facial symptoms during an attack
- Whether you become restless or agitated
- Your headache history and any previous diagnosis
- Neck symptoms where they are also part of the presentation
Suspected cluster headache should involve your doctor.
Cluster headache has specific medical treatments that can work quickly during an attack and others that aim to reduce attacks during a cluster period.
If your presentation appears consistent with cluster headache and you are not already receiving appropriate medical care, we may recommend review by your GP or neurologist.
Our role is to help clarify the presentation and contribute to your overall headache care. We do not replace medical management for cluster headache.
The right plan usually involves more than one strategy.
Cluster headache requires a different management approach from most other headache disorders.
Stopping an attack
Medical treatments such as high-flow oxygen and fast-acting triptan medication may be used to treat individual attacks. These should be discussed with your prescribing clinician.
Reducing future attacks
Preventive treatment may be recommended during a cluster period. This is usually managed by a GP, neurologist or headache physician.
Looking at the whole presentation
Where neck symptoms or other headache features are also present, we can assess whether there are additional factors worth addressing alongside your medical management.
Don't assume a severe headache is cluster headache.
If this is your first episode of severe headache, your headache has suddenly changed, or you develop neurological symptoms such as weakness, difficulty speaking, collapse or significant visual change, seek urgent medical assessment.
If your headaches are severe, one-sided and occurring in repeated attacks, start by getting the pattern properly assessed.
We'll help you understand whether the presentation appears consistent with cluster headache and what the appropriate next step should be.