April 2, 2026, 8:05 pm | Read time: 4 minutes
A short nap, some fresh air, a painkiller—for most people, headaches are a bothersome but manageable issue. Not so for those who suffer from cluster headaches. Learn how they manifest, what triggers them, and what helps against them at FITBOOK. Also: How cluster headaches differ from migraines.
They come on suddenly and are usually described as attack-like, drilling headaches around the eyes, forehead, or temples. Cluster headaches are also typically characterized by occurring at night and in phases. This means that headache episodes, where symptoms are frequent, follow varying lengths of pain-free periods.1
Typical Symptoms of Cluster Headaches
Primarily, extreme, unilateral headaches are typical of cluster headaches. These are often described as drilling, stabbing, or burning. The headache attacks usually last between 15 and 30 minutes. They can occur frequently over several days or weeks. Some people suffer from these extreme pain attacks multiple times a day during these phases. Additionally, cluster headaches can be accompanied by the following symptoms:2
- tearing and red eye on the affected side
- runny nose
- drooping eyelid
- constricted pupil
- severe restlessness with a need to move
- sweaty and reddened side of the face
- hypersensitivity to noise and light
Who Is Affected?
Cluster headaches are generally considered a rare condition. Only about one in 1,000 people is affected.3 However, it can affect anyone. Men are three times more likely to be affected than women. Men between the ages of 30 and 40 are particularly at risk. However, the condition can occur at any age.4
Difference from Migraine
Migraines differ from cluster headaches in several ways. While they can also occur on one side, patients often report pain in the front of the head. In terms of intensity, they are moderate to severe, pulsating, pounding, or throbbing. Another important distinction is the duration of a pain attack. While cluster headaches usually subside after 30 minutes, migraine attacks typically last at least four hours and can even extend up to three days.5
Causes and Risk Factors
The cause of cluster headaches is not yet understood. One hypothesis is that certain nerve cells in the brain, which are responsible for regulating the sleep-wake cycle, are “overactive.” This would also explain why the attacks mostly occur at night. Heredity might also play a role, as cluster headaches can affect multiple family members.
Better understood are so-called triggers, or causes, of cluster headaches. These include:
- alcohol
- nicotine
- being at high altitudes
- certain smells
- blinding or flickering light
- medications containing nitroglycerin, used for example to relieve chest tightness in coronary heart disease
Symptoms, Causes, Risk Factors and Treatment of Migraine
Can I combine aspirin, paracetamol, and ibuprofen?
Preventing Cluster Headaches
Since the exact causes are unknown, there are no definitive recommendations that have been proven to help prevent the possible first occurrence of cluster headaches. Instead, it is about identifying and avoiding or reducing individual triggers. Keeping a pain diary can help recognize these triggers and patterns of pain episodes.
Treatment Options
Once it is medically confirmed that the pain attacks are cluster headaches, the main focus is on treating the acute pain. This can be done with medication. Painkillers that have proven effective for migraines, known as triptans, are helpful. These are used in the form of nasal sprays. There is also the option to inject them under the skin with a pen, usually with the active ingredient sumatriptan. Many patients also find success with oxygen therapy. The therapy involves administering pure oxygen from a tank through a mask at the onset of an attack.