One of my patients complains of a headache on the left side of his head. He has it most days for three weeks and always in the morning. The pain causes him to wake and walk up and down. It lasts about two hours and it causes his left eye to water and also his left pupil goes small. He is a 40-year-old smoker and had similar headaches about a year ago when they just stopped. His vision is good and he only needs glasses for presbyopia. What is going on?

This sounds very much like a cluster headache.

Cluster headaches occur in 20 to 40-year-old male smokers. They have frequent headaches with severe pain on one side of the head and around the eye. Cluster headaches begin quickly and without warning.

There is also one or more of tearing, pupil miosis, upper lid swelling and ptosis, nasal stuffiness, and a sweaty face on the affected side. The eye involvement means that sufferers often present to eye specialists.

The pain often occurs every day and lasts between half an hour and three hours. Sufferers are woken in the morning and are agitated. The pain is very severe and is often described as a sharp, burning, or piercing sensation on one side of the head.

Sometimes they disappear without treatment after a few weeks and sometimes they last more than a year.

The pain associated with a cluster head is very very bad. It can occur between once and eight times each day.

Cluster headaches drastically reduce a person’s quality of life. They can be treated using medicines and anyone suspected of suffering from cluster headaches should see their general practitioner for advice on management.