Reviewed on : 3 Jan 2019

Reviewed by : GP Gateway Editor

Expires : 3 Jan 2021

Cluster headache is a rare but severe primary headache disorder — it is the most common trigeminal autonomic cephalalgia.

Features:

• Recurrent attacks of one-sided pain, in or around the eye or temporal region.
• Ipsilateral autonomic symptoms such as conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhoea, eyelid oedema, forehead and facial sweating or flushing.
• Brief attacks of less than 3 hours duration.
• Can be episodic with attacks occurring in periods lasting from 7 days to 1 year and separated by pain-free periods lasting at least 1 month.
• Can be chronic with attacks occurring for more than 1 year without remission, or with remission periods lasting less than 1 month.
• The cause of cluster headache is not fully understood
• Be alert for clinical features which may indicate a serious secondary cause of headache.

Referral or discussion with a specialist:

• Possible serious secondary cause of headache or where diagnosis is uncertain.
• Presents with a suspected first bout of cluster headache.
• Pregnant or breastfeeding.
• Not responding to management in primary care.

• Management of an acute attack of confirmed cluster headache in primary care:

  • Offer subcutaneous or nasal triptan (such as sumatriptan by subcutaneous injection) to people aged over 18 years (if appropriate).
  • Avoid paracetamol, NSAIDS, opioids, ergots and oral triptans.
  • Offer short burst oxygen therapy (100% oxygen at a flow rate of 12–15 litres per minute via a non-rebreather face mask for 15 to 20 minutes), if available and not contra-indicated.
  • Advise avoidance of triggers.
  • Advise risk of medication overuse headache.
  • Identifying and managing any comorbidities such as depression, anxiety, and sleep apnoea.
  • Provision of written and oral patient information on cluster headache and support organizations.