Cluster Headache Attack - Right Now

You are going through one of the most painful things a person can experience. Here is what to do right now.

This page is designed to be read quickly, during an attack or by someone helping you.

Awaiting clinical review · This page is awaiting completed review by a New Zealand neurologist. It is based on ICHD-3 criteria and published clinical guidelines, and is not a substitute for medical advice. How we prepare clinical content
First time, or not yet diagnosed?

If this is your first severe headache, go to the emergency department and be assessed in person. A first severe headache needs assessment because conditions such as meningitis and subarachnoid haemorrhage have to be ruled out, and those assessments should not be missed.

Call 111 now if this is the worst or most sudden headache of your life, or if you have weakness, confusion, fever, a stiff neck, or changes to your vision or speech.

Do not treat an undiagnosed severe headache yourself at home. The steps on this page are for people with a confirmed cluster headache diagnosis.

If you have oxygen - use it now

High-flow oxygen: 12–15 litres per minute

Need a dark screen timer during the attack? Open the low-glare oxygen timer.

  • 1. Use a non-rebreather mask - not a nasal cannula and not a simple face mask
  • 2. Set the flow rate to 12–15 litres per minute
  • 3. Breathe deeply and normally - continue for up to 20 minutes
  • 4. Sit upright or pace - do not lie down (many patients find movement helps)

High-flow oxygen aborts attacks in approximately 70–80% of cluster headache patients, typically within 15–20 minutes. It has no significant side effects.

If you have sumatriptan injection - use it

Sumatriptan 6mg subcutaneous injection

  • • Inject into the outer thigh or abdomen - follow the instructions in your kit
  • • Works for most patients within about 10–15 minutes
  • • Tablets do not work quickly enough - only use the injection form
  • • If the first injection does not work, do not give a second injection for the same attack - use oxygen instead. A second injection is only for a later, separate attack, at least 1 hour later, and no more than 2 injections (12 mg) in 24 hours.

Do not use sumatriptan if you have cardiovascular disease, uncontrolled high blood pressure, or have been advised not to by a doctor.

At the emergency department or GP - what to say

Emergency departments and GPs may not be familiar with cluster headache treatment. Say exactly this:

"I have cluster headache. I need:

  • 1. 100% oxygen at 12–15 litres per minute via a non-rebreather mask
  • 2. Sumatriptan 6mg subcutaneous injection if oxygen is not available

Standard pain relief (paracetamol, morphine, ibuprofen) does not work for cluster headache and will not help me."

Print the emergency wallet card to carry with you so this information is always available.

What does NOT work for cluster headache

  • Paracetamol / Panadol
  • Ibuprofen / Nurofen
  • Codeine or tramadol
  • Morphine or other opioids
  • Lying down in a dark room (unlike migraine)
  • Sumatriptan tablets (too slow - only the injection works)
  • Waiting it out - it will end on its own but standard pain relief will not speed this up
After the attack - what to do next

Once the attack has passed, the most important thing is to ensure you have the right treatment on hand for the next one. Talk to your GP about getting oxygen prescribed. Health NZ confirmed in July 2026 that it funds high-flow oxygen for cluster headache. Talk to them also about sumatriptan injectable, which is funded through PHARMAC. Ask for a referral to a neurologist if you do not have a confirmed diagnosis.

For free health advice any time, you can call Healthline on 0800 611 116 (free, 24/7 nurse advice).

You are not alone

This pain is overwhelming, but the attack will pass. If you are thinking about harming yourself, you don't have to face it alone - free call or text 1737 any time to talk with a trained counsellor. In an emergency, call 111.