Intractable episodic cluster headache

Cluster headache commonly causes intense one-sided pain around or behind the eye, with tearing, a blocked or runny nostril, eyelid swelling, or facial sweating on the same side. Attacks can occur repeatedly over a period, sometimes at similar times of day, followed by symptom-free intervals. Intractable attacks may last longer than expected, return despite treatment, or interfere with sleep and daily function.

A clinician will consider the timing, side, associated eye and nose symptoms, medicines used, and any change from your usual pattern. A new or atypical headache may need assessment for another cause.

Seek a GP or headache-clinic review if your usual treatment is failing, attacks are clustering more often, or you are using acute medicines repeatedly. Keep an attack diary with start time, duration, side, triggers, associated symptoms, and treatment response. Follow the prescribed plan and avoid changing doses without guidance. Alcohol can trigger attacks during an active cluster period for some people.

Get emergency help for a sudden explosive headache, new weakness, confusion, seizure, fainting, fever with a stiff neck, persistent vomiting, new vision loss, or a headache after head injury. Urgent review is also needed when a familiar pattern changes sharply or pain does not settle as expected.

Ask whether the pattern fits cluster headache, which treatment should be used at the start of an attack, whether preventive treatment is appropriate, and how to avoid medication overuse. Ask which symptoms mean you should attend emergency care.