Are cluster headaches the most painful type of headache?

An attack commonly centres around one eye or the temple and may spread across one side of the face. The eye on that side can water or look red, while the nostril may block or run. Many people feel driven to pace rather than lie quietly. Attacks tend to follow a recognisable pattern for an individual, with symptom-free periods possible between bouts. A headache with facial pain can have other causes, so a new pattern deserves a clinical assessment.

Record when the pain began, which side is affected, how long it lasted, and any eye or nose changes. Move to a calm, well-ventilated place and avoid alcohol if it has triggered attacks before. Over-the-counter pain medicines often act too slowly for a cluster attack; a clinician can discuss fast-acting treatment and a plan to reduce further attacks. Arrange a GP consultation for a first episode, a changing pattern, or repeated attacks.

Seek emergency help for a sudden explosive headache, new weakness, fainting, confusion, seizure, fever with a stiff neck, loss of vision, or severe eye pain with vision changes. Seek prompt medical advice when the pain is new, unlike previous headaches, follows a head injury, or occurs during pregnancy. Do not assume intense pain alone identifies the cause.

Could this pattern be cluster headache or another cause? Which treatment should I use at the first sign of an attack? What symptoms should prompt emergency care? Should I keep an attack diary or arrange specialist review?