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Cluster Headache

Percorso specialistico nelle cefalee resistenti.

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  2. Craniofacial pain: specialist diagnosis and treatment
  3. Cluster Headache

Recognising attacks, planning care

Cluster headache can disrupt sleep, work and daily life with extremely intense attacks of pain. People affected need a precise diagnosis, rapid treatment for attacks and a strategy to prevent them.

The pain typically affects one side of the head, especially around the eye or temple. Without treatment, attacks generally last 15 to 180 minutes and may recur several times in the same day.

The Centro Cefalee Torino – PONOS Clinic provides specialist evaluation and treatment for cluster headache, with particular attention to persistent, recurrent or treatment-resistant cases.

What is cluster headache?

Cluster headache belongs to the group of trigeminal autonomic cephalalgias (TACs).
It is characterised by short but repeated attacks of severe pain, which occur in cyclical periods (“clusters”) lasting weeks or months, separated by remission phases.
The pain is typically:

  • unilateral
  • extremely intense
  • of rapid onset
  • located around the eye or temple

Symptoms of cluster headache

During an attack the following symptoms may occur:

  • severe orbital or temporal pain
  • tearing and redness of the eye
  • nasal congestion or rhinorrhoea
  • facial sweating
  • eyelid ptosis or miosis
  • motor restlessness

Unlike migraine, patients usually do not seek rest during the attack, but tend to move or pace due to the intensity of the pain.

Episodic and chronic cluster headache

This distinction is fundamental when choosing treatment. Two main forms are recognised.

Episodic cluster headache

  • periods of attacks alternating with complete remissions
  • pain phases may last weeks or months

Chronic cluster headache

  • absence of remission or very short remission periods
  • greater impact on quality of life
  • greater therapeutic complexity

Diagnosis of cluster headache

Diagnosis is primarily clinical and is based on:

  • characteristics of the pain
  • duration and frequency of attacks
  • presence of autonomic symptoms
  • cyclical pattern over time

Specialist assessment also helps distinguish cluster headache from other headaches and conditions that can mimic it, and determines which investigations are needed. An attack diary and a list of treatments already tried help define the care pathway.

When cluster headache does not respond to treatment

If attacks persist despite preventive therapy or if the condition becomes chronic, evaluation in a specialist centre for refractory headache disorders may be useful.

Any interventional pathway requires a confirmed diagnosis and review of previous treatments, benefits and side effects, in coordination with the specialist managing the headache.

The role of the sphenopalatine ganglion

The sphenopalatine ganglion (SPG) participates in autonomic pathways involved in symptoms such as tearing and nasal congestion. It is therefore a target studied for certain cluster headache treatments.

Local anaesthetic blocks, radiofrequency and electrical stimulation using a device are different procedures. Results obtained with one technique cannot automatically be attributed to another. SPG pulsed radiofrequency is not a first-line treatment: any use requires specialist selection and discussion of the limited evidence, risks and alternatives.

Treatment of cluster headache

Treatment has two goals: to stop an attack rapidly and reduce subsequent attacks. The pathway includes:

  • Acute treatment: high-flow 100% oxygen and subcutaneous sumatriptan are among the recommended treatments, subject to prescription and assessment of contraindications.
  • Prevention: verapamil is an established option for reducing attacks and requires electrocardiographic monitoring.
  • Transitional treatment: in certain situations, corticosteroids or greater occipital nerve blocks are used while preventive treatment is being established.
  • targeted interventional treatments in selected patients

Patients with chronic or treatment-resistant forms often require a multidisciplinary and personalised approach.

Specialist centre for refractory cluster headache

PONOS Clinic assesses complex cases and the possible indication for an interventional treatment, coordinating care with the specialist managing the headache. The choice depends on the clinical picture, previous treatments and the balance between expected benefits and risks. Relevant topics include:

These treatments are assessed individually after specialist evaluation.

Scientific references: International Headache Society – ICHD-3 criteria for cluster headache; May et al., European Academy of Neurology guidelines, 2023.

When to consult a specialist centre

Evaluation in a dedicated center is recommended when:

  • attacks are very frequent or disabling
  • treatments are not effective
  • the condition becomes chronic
  • pain significantly interferes with daily life

Bring neurological reports, available investigations, an attack diary and a list of previous treatments, including benefits and side effects. Assessment helps clarify the diagnosis and discuss appropriate options.

Role of Centro Cefalee Torino

The Centro Cefalee Torino (in Italian) – PONOS Clinic provides specialist evaluation for patients with episodic or chronic cluster headache, particularly in complex or treatment-resistant cases.

Request an assessment at PONOS Clinic
Dr Evangelos Panagiotakos MD
Anaesthesiologist – Interventional Pain Specialist

Scientific references

Selected references for further reading on the diagnoses and treatments discussed on this page.

  1. May A et al. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol. 2023;30:2955–2979. (Guidelines)
  2. Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation – a systematic review. J Headache Pain. 2017;18:118. (Systematic review)

These sources distinguish nerve blocks, radiofrequency and neurostimulation: results from one technique cannot automatically be applied to another.