Cluster headache: What helps?

Photo of a man holding his head in pain

Cluster headaches often go undiagnosed for a long time. There are various treatments for this very severe pain. Over-the-counter painkillers like ibuprofen or acetaminophen (paracetamol) do not work in the treatment of acute cluster headaches.

Cluster headaches are very intense attacks of pain around one eye or one temple. They occur in bouts (clusters) over a certain time period. People with this type of primary headache are often pain-free for months, but may then have phases with up to several attacks per day. The cluster headaches are then said to be "episodic." Some people have chronic cluster headaches instead, where they have regular headache attacks for more than a year without any longer-lasting breaks between them.

It can take months, or even years, for the pain to be diagnosed as cluster headaches. Once they have been diagnosed correctly, the attacks can be treated in various ways.

Oxygen therapy

Many people find that breathing pure oxygen during an attack relieves the pain. This involves using a face mask that is connected to an oxygen cylinder. You can control how much oxygen flows through the mask per minute using a regulator. Experts recommend at least 8 to 12 liters per minute. You sit upright, cover your nose and mouth with the mask, and breathe the oxygen for 15 to 20 minutes.

Oxygen therapy has few side effects and is well tolerated by most people. If you have chronic obstructive pulmonary disease (), talk to your doctor about whether this type of oxygen therapy is suitable for you.

Before starting oxygen therapy, most people will stay in a hospital for one or two days to find out whether – and at what dose – oxygen relieves their pain. After that, they can continue the treatment at home. There are portable units that you can use when traveling. In Germany, statutory health insurers pay for oxygen therapy after an application has been submitted.

Migraine medications (triptans)

Two medications for migraine attacks can also be used to relieve cluster headaches. These "triptan" medications are called sumatriptan and zolmitriptan.

How are migraine medications used?

When used for the treatment of cluster headaches, sumatriptan is injected just under your skin – using a pre-filled pen, for instance. You place it on the skin and then inject the medication by pressing a button. It is best to inject it as soon as the pain starts – for example, into your belly, upper arm or thigh. People often feel a noticeable improvement after only 10 to 15 minutes.

When zolmitriptan is used for cluster headaches, it is delivered in the form of a nasal spray. Here it's a good idea to spray the medication into the nostril on the pain-free side of the head.

An analysis of several studies showed that triptans don’t relieve cluster headaches when taken in the form of tablets. It might take too long for the effect of tablets to kick in – cluster headache attacks often already go away on their own by then.

What can you expect from these medications?

Both of the triptans can relieve the pain. Studies that compared sumatriptan to a placebo (both injected at the beginning of the cluster headache) found the following: After 15 minutes, the symptoms had gone away completely in

  • 15 out of 100 people who were given a placebo, and
  • 42 out of 100 people who were given sumatriptan.

Zolmitriptan nasal spray is thought to be slightly less effective than sumatriptan here.

Both of the triptans can cause side effects like nausea and dizziness. They can also make your blood vessels narrower. Because of this, they’re not recommended for people with untreated high blood pressure or coronary artery disease.

Other treatments

It is not clear whether other treatments can relieve cluster headaches. Nasal sprays containing the local anesthetic lidocaine are sometimes used if, for instance, the headache attacks strike several times a day. Using a triptan injection or nasal spray for each attack would then result in an overdose and more side effects.

The vast majority of cluster headaches can be relieved with oxygen or medications. In the rare cases where they can’t, people may have a surgical procedure that aims to reduce the pain by stimulating certain nerves. There is currently a lack of research on the effectiveness and possible side effects of these procedures.

Bennett MH, French C, Schnabel A et al. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst Rev 2015; (12): CD005219.

Deutsche Gesellschaft für Neurologie (DGN). Clusterkopfschmerz und trigeminoautonome Kopfschmerzen (S1-Leitlinie, in Überarbeitung). AWMF-Registernr.: 030-036. 2015.

Gaul C, Diener HC, Müller OM. Cluster headache: clinical features and therapeutic options. Dtsch Arztebl Int 2011; 108(33): 543-549.

Hacke W. Neurologie. Berlin: Springer; 2016.

Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol 2018; 17(1): 75-83.

International Headache Society (IHS). Die Internationalen Klassifikation von Kopfschmerzerkrankungen, 3. Auflage – ICHD-3. 2018.

Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev 2013; (7): CD008042.

Ludwig Boltzmann Institut für Health Technology Assessment (LBI-HTA). Stimulation des Ganglion Sphenopalatinum (SPG) bei therapierefraktärem Clusterkopfschmerz. Systematischer Review. 2015.

May A, Evers S, Brössner G et al. Leitlinie zur Diagnostik, Therapie und Prophylaxe von Cluster-Kopfschmerz, anderen trigeminoautonomen Kopfschmerzen, schlafgebundenem Kopfschmerz und idiopathisch stechenden Kopfschmerzen. Nervenheilkunde 2016; 35: 137-151.

Robbins MS, Starling AJ, Pringsheim TM et al. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache 2016; 56(7): 1093-1106.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on April 5, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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