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Cluster Headaches


Cluster headaches are recurring attacks of excruciating pain on one side of the head, often behind an eye. The pain may extend to the forehead, nose, cheek, upper jaw or back of the head on the same side. The attacks often happen multiple times per day, with each attack lasting less than three hours, even without treatment. Most often, the attacks occur every day for several weeks or months and then subside for a period, though for some people the attacks can continue for months or even years.

Men have cluster headaches three to four times more often than women. Generally, this condition does not run in families.

Our approach to cluster headaches

Our headache specialists – neurologists who focus on treating headaches –provide comprehensive assessments and care. Treatments include medications that interrupt cluster headache cycles and halt individual cluster headache attacks. We see patients from around the world who have difficult-to-treat headache disorders, and are committed to delivering effective care with the utmost compassion and respect. When needed, our specialists work closely with other experts at UCSF, such as alternative medicine providers, to better manage cluster headaches.

Awards & recognition

  • Among the top hospitals in the nation

  • Best in the West and No. 3 in the nation for neurology & neurosurgery

Signs & symptoms

Cluster headache attacks may occur nearly every day or several times a day for weeks or months and then disappear for months or even years. Attacks may last from 15 minutes to three hours, and often occur during the night.

There are two kinds of cluster headache: episodic and chronic. Those suffering from episodic cluster headaches have relatively long, pain-free remissions between headaches. Chronic cluster headache sufferers do not have long remissions. If during the past year or longer, you have had only one month or less of relief between headache attacks, you may have chronic cluster headache. About 10 percent of people with cluster headaches are considered chronic sufferers.

Other symptoms, which typically occur on the same side as the pain, include:

  • Red or teary eyes
  • Runny or stuffy nose
  • Facial swelling


Cluster headaches are characterized by a specific type of pain and pattern of attacks. Keeping a headache journal is a great way to track the location, severity and duration of pain; medications; and possible headache triggers.

A physical exam may help your doctor detect signs of a cluster headache. One of your pupils may appear smaller than the other or your eyelid may droop.

If your doctor suspects a tumor or aneurysm, he or she may order one or more of the following tests:

  • Computerized tomography (CT) scan. A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to construct a 3-D, cross-sectional image.
  • Magnetic resonance imaging (MRI). An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain. Under the right circumstances, MRI and other imaging procedures allows doctors to actually see how the larger structures in the brain are involved during migraine and headache.


Taking medications to prevent cluster headaches before they occur is typically the most effective treatment for cluster headaches. These medications include:

  • Calcium channel blockers. Calcium channel blockers, such as Verapamil, which relax the muscles in the walls of your blood vessels, may help prevent cluster headaches.
  • Anti-seizure medications. Medications used to control seizures in conditions such as epilepsy may be prescribed to help control cluster headaches. These include divalproex topiramate and gabapentin.
  • Lithium. This medication may help prevent chronic and episodic cluster headaches.
  • Corticosteroids. These anti-inflammatory drugs, such as prednisone, may provide relief from headache pain.

If your doctor prescribes medication, be sure to ask:

  • How often the medication should be taken
  • If the medication should be taken with meals or on an empty stomach
  • What to do if pain or other symptoms persist

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

Keeping a Headache Journal

Keeping a headache journal is a great way to track the location, severity, duration, and any medications that may trigger headaches. Learn more.

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