What should you know about episodic cluster headache?

Cluster headache attacks are typically focused around one eye or temple and may cause tearing, a blocked or runny nostril, eyelid swelling or a smaller-looking pupil on the same side. People often feel restless during an attack rather than wanting to lie still. In the episodic form, attacks occur in bouts, then settle for a remission period; the timing varies between people and between bouts.

A headache or Facial Pain and Pressure does not by itself identify cluster headache. A clinician uses the side, speed of onset, attack pattern, associated eye or nose signs and neurological examination to distinguish it from migraine and other causes.

Keep an attack diary with the start time, duration, side, eye or nose symptoms, possible triggers and medicines used. Arrange a GP Consultation for a new or recurring pattern so the diagnosis can be checked and a plan made for stopping attacks and reducing a bout. Avoid alcohol during a known cluster period if it reliably triggers attacks, and follow prescribed treatment instructions rather than repeatedly using unplanned pain medicines.

Seek emergency help for a sudden severe headache unlike previous attacks, headache after a head injury, weakness, numbness, confusion, fainting, seizure, fever with a stiff neck, or new vision loss. A first severe one-sided headache also deserves prompt assessment, especially when eye redness, a drooping eyelid or neurological symptoms are present.

Does my attack pattern fit cluster headache or another headache disorder? What should I use at the start of an attack? How can we protect sleep and daily activities during a bout? Which symptoms should send me to emergency care?