Cluster headaches: what you should know

The pain often sits behind or around one eye and can make normal activity feel impossible. During an attack, the affected eye may water, the eyelid may droop, or the nostril may run or feel blocked. Unlike many people with migraine, someone with cluster headache may pace, rock, or feel unable to stay still. Episodes can return in groups over a period of time, then stop for a while. Facial pain and pressure has several possible explanations, so diagnosis depends on the full history and examination.

Write down the side of the pain, its starting time, duration, associated eye or nose symptoms, sleep disruption, and possible triggers. Avoid alcohol during a period when attacks are occurring if it seems to bring them on. Book a GP consultation to review a first or recurring pattern. Prescription options can work more quickly than ordinary painkillers for some people, and preventive treatment may be considered when attacks repeat.

Get emergency help for a sudden severe headache unlike anything before, weakness or numbness, difficulty speaking, confusion, collapse, seizure, fever with neck stiffness, or new loss of sight. A painful red eye with visual change also needs urgent assessment. Contact a clinician promptly if headaches are changing, following an injury, or beginning during pregnancy.

What features make this cluster headache rather than migraine or another disorder? What should I do before the next attack becomes severe? Which medicines are suitable for me? Do I need a neurological assessment?