Frequently Asked Questions (FAQ)
Sources checked: 8 October 2026 · no physician review
Basics
What is cluster headache?
Cluster headache is considered one of the most painful conditions known to medicine. The attacks occur on one side — orbital, supraorbital, or temporal — and typically last 15 to 180 minutes when untreated. Possible accompanying autonomic symptoms include tearing, a blocked or runny nose, drooping eyelid, or a red eye on the affected side. The attacks often come in periods — so-called "clusters" — over weeks or months. Even though the condition is rare and hardly anyone around you knows it: you are not alone.
To the Research page →Why is it called the "suicide headache"?
This nickname refers to the extreme pain intensity documented in the medical literature. It is not a clinical term. People affected report that the pain during an attack is harder to endure than anything else they have experienced. If you are in a crisis during or between attacks, please contact a crisis helpline immediately. For questions about diagnosis and treatment, please see a neurologist.
How common is cluster headache?
Cluster headache is a rare neurological disorder. Men are more frequently diagnosed than women, but cluster headache is not exclusively a male condition. Years often pass before a correct diagnosis is reached, because the condition is barely known in the general population and its symptoms can be mistaken for other disorders.
What is the difference between episodic and chronic cluster headache?
Episodic cluster headache involves at least two untreated bouts lasting seven days to one year, separated by attack-free remissions of at least three months. Chronic cluster headache requires an attack pattern lasting at least a year, with no remission or with individual remissions shorter than three months. Clinical classification considers the full course.
Source: IHS criteria →How is cluster headache diagnosed?
Diagnosis follows the ICHD-3 criteria of the International Headache Society. Key features are unilateral attacks with autonomic accompanying symptoms and/or marked restlessness and the characteristic time pattern. There is no single blood test or biomarker that confirms the diagnosis. A thorough clinical history taken by an experienced neurologist is therefore essential. Please consult a neurologist for diagnosis and treatment.
Source: IHS criteria →What causes cluster headache?
The exact causes are not yet fully understood. Current research points to involvement of the hypothalamus and the trigeminal system. Cluster headache is not a psychosomatic condition — the pain is real and has a neurological basis. No single definitive cause has been identified so far. For further medical questions please consult a neurologist.
Is cluster headache curable?
Honestly: there is currently no cure in the conventional sense. Some people experience a spontaneous shift from chronic to episodic cluster headache, or active periods stop entirely — but this is not predictable. Medical treatments can substantially reduce attack frequency and duration and significantly improve quality of life. Which options are right for you is a conversation to have with a neurologist.
How long does a cluster attack last?
An untreated attack typically lasts 15 to 180 minutes. Migraine attacks in adults typically last four to 72 hours. The typical cluster attack frequency ranges from one attack every other day to eight attacks daily, often occurring at similar times of day — frequently at night. For medical questions about your attacks, please consult a neurologist.
Source: IHS criteria →How long does a cluster period last?
An active period usually lasts four to twelve weeks, but can be shorter or longer. It is typically followed by a remission phase lasting months to years. Longer attack-free recovery periods may be absent; shorter remissions are also possible in chronic cluster headache. How your individual pattern looks is best assessed by a neurologist.
Attacks & Everyday Life
What helps immediately during an attack?
I understand how urgent this question is — and that is exactly why I want to be honest with you: established acute treatments exist, for example high-flow oxygen or triptans. But dosage, application, and whether these options are right for you must be tailored individually with a neurologist. Self-treatment without guidance can cause harm. Please raise the topic of acute treatment directly at your next neurology appointment.
How do I sleep despite nocturnal attacks?
Nocturnal attacks are well documented. However, they cannot be clearly attributed to a particular sleep stage such as REM sleep. Practically speaking, a regular sleep-wake schedule, clear agreements with your partner for what happens at night, and a short attack diary kept at the bedside can help. Both the exhaustion and the sleep situation can also be topics in counseling. For medical sleep aids or preventive treatment, please consult a neurologist.
Source: Sleep study →Can I do sports?
Outside of active periods, regular physical activity is generally positive. During an active period, intense exertion can trigger attacks in some people — but not in others. This is highly individual. Observe your own pattern and discuss it with a neurologist before training intensively during an active period.
How do I explain cluster headache to my employer?
This question is more burdensome than it sounds — behind it often lies fear of incomprehension or consequences. In counseling I can help you prepare for this conversation: what to say, what to leave out, what accommodations at work would actually help. A brief, factual description of the condition — without oversharing — is often more effective than a lengthy explanation.
Article: Cluster headache at work →What can I tell my family when I want to be alone during an attack?
The desire to be alone during an attack is very common in cluster headache — and well documented. Unlike migraine, people with cluster headache often seek movement and counter-stimulation rather than quiet and darkness. When family members do not know this, withdrawal can feel hurtful. My suggestion: agree on a signal before the next attack comes — a brief gesture or a message that means: "I need space right now, not because you are doing anything wrong."
Counseling for relatives →What is a cluster diary and why does it help?
A cluster diary is a simple log in which you record the time, duration, intensity, and possible triggers of each attack. It has several benefits: your neurologist can use it to fine-tune treatment. It can give you a sense of agency — even when attacks come, you are actively observing. And it makes starting counseling easier because we can identify patterns together.
To the Research page →How do I cope with anticipatory anxiety about the next attack?
The anxiety between attacks is a burden of its own — and it is often underestimated. Once you have experienced how suddenly an attack can strike, part of your awareness is always waiting for the next one. That is not weakness; it is an understandable response of the nervous system. This is precisely where counseling can help: not to treat the attacks themselves, but to make the time between them more livable.
Counseling between periods →Treatment
What treatment options exist for cluster headache?
Medically, a distinction is made between acute treatment (relieving an ongoing attack), prophylaxis (reducing attack frequency), and neuromodulatory approaches. Which options are suitable for you depends on your pattern, your history, and other factors. I deliberately do not list dosages or protocols here — these are decisions that only a neurologist can make together with you. Please seek out a specialized neurology practice.
What is oxygen therapy for cluster headache?
High-flow oxygen is an established acute treatment for cluster headache. It is inhaled through a suitable non-rebreather mask with a reservoir bag or a demand-valve system and can abort an attack effectively in many people. Its use requires a prescription, appropriate equipment, and proper instruction. How this works for you specifically is a conversation to have with a neurologist — applied incorrectly, oxygen provides no benefit.
Source: EAN guideline →Does diet play a role in cluster headache?
Alcohol is a well-documented trigger during an active period and should be avoided at that time. Whether general dietary changes influence the condition is not well supported by evidence — there is no diet that reliably improves cluster headache. Be skeptical of any claims to the contrary. For medical questions about triggers and treatment, please consult a neurologist.
Can I shorten a cluster period?
Preventive treatments aim to reduce attack frequency. This does not establish that the entire bout can reliably be shortened. The treating neurologist determines whether a particular treatment is suitable.
Source: EAN guideline →Counseling & Support
Is this medical treatment or counseling?
I offer psychosocial counseling – not medical treatment and not psychotherapy. The medical treatment of your attacks (for example with oxygen or medication) therefore stays with your neurologist. I start where the pain shapes your life: the fear of the next attack, the exhaustion, and the strain on your relationship and your job. As someone affected myself, I know what you are talking about.
Who is the counseling for – only for those affected?
For both. I support people who suffer from cluster headache themselves, as well as relatives who accompany someone through the attacks and often reach their own limits in the process. The people around the patient are frequently forgotten – yet they carry a great deal.
Counseling for relatives →How does the free initial consultation work?
The initial consultation takes place online via video call and lasts approx. 20-30 minutes. It serves for us to get to know each other. You briefly describe your current situation to me and what is burdening you. I then outline how I work and what we can do. What is important: It is not a sales conversation, but a "sniffing out". Is the chemistry right? Do you feel understood? Afterward, you can decide in peace whether you want to work with me.
How are the costs composed and are there packages?
Billing is by the minute: €2 per minute (€120 per hour) – you pay only for the time we actually spend talking. For a clear framework, you book an hourly package in advance (e.g. 5, 10, or 15 hours). This has two reasons: First, it gives us a defined financial and time framework. Second, booking a package is a strong psychological signal to yourself: "I am now taking time for myself and my health." In the free initial consultation, we clarify together which package makes the most sense for your request.
How does the minute-accurate billing work?
Fairness is extremely important to me. That is why I deduct from your hourly package only the exact time that we actually speak with each other. If a conversation comes to a good conclusion after 43 minutes, we end it there and you "save" the remaining 17 minutes for next time. You never have to "fill" an hour just because it is paid for. This guarantees maximum flexibility and efficient use of your budget.
What happens financially if I have to cancel at short notice due to an attack?
Absolutely nothing. I know that you cannot plan your attacks. Therefore, a special rule applies with me: In the event of an acute attack, the usual 48-hour cancellation period is suspended. Simply write me a short message (or have someone write it) as soon as possible. The hour does not expire and is not charged. We simply look for a new appointment without complications when you are feeling better.
Can I submit the counseling to health insurance?
As a systemic counselor (Life and Social Counselor), I settle my fee directly with you. Statutory health insurance companies usually do not cover the costs. However, some private supplementary insurances reimburse fees for life and social counseling – it is best to ask your insurance company directly. Your advantage as a self-payer: You enjoy absolute discretion, no diagnoses appear in your medical file, and you usually get appointments very promptly without months of waiting time.
Factual Questions About the Condition
This FAQ answers questions about the counseling offer. Factual information about the condition itself — what cluster headache is, what happens during a cluster attack, what the diagnosis codes G44.0 and R51 on your medical report mean, and which treatments exist — lives on our information page.
Cluster headache explained →Psychosocial counselling only — not medical advice, not psychotherapy. In a crisis, contact your local emergency services.