Thunder cluster headaches: what to know

Cluster headache is a neurological condition in which severe pain is often centred around one eye or the temple. The painful side may have a watery or red eye, a blocked or runny nostril, eyelid swelling, or marked restlessness. Attacks can recur in a recognisable pattern, but a first or unusually abrupt attack should not be labelled cluster headache at home.

The word thunder describes speed and intensity, not a diagnosis. A sudden headache that peaks immediately can arise from a problem needing emergency assessment. The distinction depends on examination and, when indicated, urgent tests.

Stop exertion, sit or lie somewhere safe, and note the exact time the pain began, how quickly it peaked, its location, and any eye, facial, speech, movement, or awareness changes. Do not drive yourself if the pain is severe or you feel unwell.

For a first sudden severe headache, contact emergency services or attend an emergency department now. A GP consultation can help with a recurring, previously assessed pattern, but should not delay emergency assessment of a thunderclap symptom.

Emergency care is needed for sudden maximum-intensity pain, especially with fainting, confusion, weakness, numbness, trouble speaking, seizure, vision change, repeated vomiting, fever with neck stiffness, or pain after injury or exertion. Do not wait for the headache to settle before seeking help.

Even if symptoms improve, urgent assessment is sensible when the episode is new, different, or unusually intense. Bring a list of medicines and describe any previous headache pattern.

Ask: Does my attack fit cluster headache or another cause? Do I need emergency tests? What should I record during future attacks? Which treatments are appropriate, and what symptoms mean I should call emergency services?