Cluster headache attack plan, online

Common symptoms

• Very strong pain on one side of the head, near or behind the eye
• A red or watering eye, or a stuffy or runny nose, on the same side
• A swollen or drooping eyelid, or a smaller pupil, on the same side during an attack
• Feeling restless during an attack

May fit online care

• Adults 18 and older
• You are 18 to 64
• A clinician (a doctor, nurse practitioner, or physician assistant) told you that you have cluster headache
• Your attacks are like the ones your clinician diagnosed
• In the last 12 months, you had a blood pressure reading below 140/90. A pharmacy machine or a home cuff counts
• If you never used a triptan, you are 49 or younger
• You have none of the warning signs below

Look for another care setting

• A headache that reached full strength in about a minute (call 911 or go to the ER now).
• A headache worse than any attack you have had before (call 911 or go to the ER now).
• Fever with a stiff neck, or a new rash (call 911 or go to the ER now).
• Confusion, or being so sleepy that it is hard to wake up (call 911 or go to the ER now).
• New weakness, numbness, a drooping face, trouble speaking, clumsiness, or double vision, even if it went away (call 911 or go to the ER now).
• Sudden loss of vision, even if it went away (call 911 or go to the ER now).
• A drooping eyelid or a smaller pupil on one side that you never had before (call 911 or go to the ER now).
• A drooping eyelid or a smaller pupil on one side that stays after the attack is over (call 911 or go to the ER now).
• Chest pain, pressure, or tightness, or trouble breathing (call 911 or go to the ER now).
• Fainting, or a seizure (call 911 or go to the ER now).
• Halos around lights (call 911 or go to the ER now).
• Blurry vision that stays after the attack is over (call 911 or go to the ER now).
• After a shot, now or if it started in the last 24 hours, chest discomfort that lasts more than a few minutes or comes back: call 911 or go to the ER now, and use no more shots.
• After a shot, now or if it started in the last 24 hours, severe tightness, pain, pressure, or heaviness in your chest, throat, neck, or jaw: call 911 or go to the ER now, and use no more shots.
• After a shot, now or if it started in the last 24 hours, pain in your arms, back, or stomach, a cold sweat, or shortness of breath: call 911 or go to the ER now, and use no more shots.
• After a shot, now or if it started in the last 24 hours, hives, swelling of your lips, tongue, face, or throat, or trouble breathing: call 911 or go to the ER now, and use no more shots.
• After a shot, on any day since your last fill, sudden weakness, trouble speaking, or loss of vision, even if it went away: call 911 or go to the ER now, and use no more shots.
• After a shot, now or if it started in the last 24 hours, sudden or severe belly pain, or bloody diarrhea: call 911 or go to the ER now, and use no more shots.
• After a shot, now or if it started in the last 24 hours, seeing things that are not there, agitation, a fast heartbeat, a high body temperature, tight muscles, or trouble walking: call 911 or go to the ER now, and use no more shots.
• More than 2 shots in 24 hours, the last of them in the last 24 hours: call 911 or go to the ER now, and use no more shots.
• Thoughts of ending your life or of hurting yourself, or thinking you would be better off dead right now or between attacks, or a plan: call or text 988 now, and call 911 if you are in danger.
• A headache that is different from your usual attacks, such as a new place, a new kind of pain, or no eye or nose signs (go to the ER or urgent care today).
• In this run of attacks, one attack that lasted longer than 3 hours when you did not treat it (go to the ER or urgent care today).
• A headache after a head or neck injury (go to the ER or urgent care today).
• After a shot, now or if it started in the last 24 hours, fingers, toes, legs, or feet that turn cold, pale, blue, numb, or painful: go to the ER or urgent care today, and use no more shots.
• Jaw pain when you eat, or a sore scalp, with your headaches (see a doctor in person today).
• A fever, chills, night sweats, or weight loss with your headaches (see a doctor in person today).
• One of the "after a shot" problems above, or more than 2 shots in 24 hours, the last of them more than 24 hours ago, happened after a shot more than 24 hours ago and is over (but sudden weakness, trouble speaking, or loss of vision is always 911, even if it went away): see a doctor in person within 7 days, and use no more shots until a doctor has checked you.
• No clinician has diagnosed your headaches, or you are not sure what the diagnosis is (see a doctor in person within 7 days).
• Your cluster headaches first started when you were 50 or older (see a doctor in person within 7 days).
• Your attacks are getting worse, or last longer than usual (see a doctor in person within 7 days).
• Your usual treatments are not helping (see a doctor in person within 7 days).
• Your attacks do not match your diagnosis, or you are not sure (see a doctor in person within 7 days).
• Your headaches come on with coughing, straining, or sex (see a doctor in person within 7 days).
• Your headaches change a lot with position (see a doctor in person within 7 days).
• You have or had cancer, or you have HIV or an organ transplant (see a doctor in person within 7 days).
• You take a medicine that weakens your immune system (see a doctor in person within 7 days).
• You are 65 or older (see your own doctor).
• A clinician told you that you have a headache that is not cluster headache or migraine (see your own doctor).
• Heart disease, such as angina, a heart attack, silent heart damage, or coronary artery spasm (see your own doctor).
• You had a stroke or mini-stroke (see your own doctor).
• Hemiplegic or basilar migraine (see your own doctor).
• Poor blood flow in your legs or arms (see your own doctor).
• Bowel disease from poor blood flow (see your own doctor).
• Wolff-Parkinson-White syndrome, or another extra electrical pathway in the heart (see your own doctor).
• Severe liver disease (see your own doctor).
• High blood pressure that is not under control (see your own doctor).
• Two or more risk factors for heart disease: high blood pressure even if treated, high cholesterol, smoking or vaping now or in the past year, diabetes, a BMI of 30 or more, or a parent or sibling with early heart disease (see your own doctor).
• You never used a triptan and you are 50 or older (see your own doctor).
• Your last blood pressure reading was 140/90 or higher (see your own doctor).
• You have no blood pressure reading from the last 12 months (see your own doctor).
• You took an MAOI antidepressant in the last 2 weeks (see your own doctor).
• You ever had an allergic reaction to sumatriptan (see your own doctor).
• You are pregnant or might be pregnant (see your own doctor).
• You are under 18 (see your own doctor).
• You do not accept the safety points in this visit (message us).
• The first shot gives you no relief at all (message us, do not use a second shot in that attack, and do not use a shot for a later attack until we reply; if you have oxygen, use it).
• Your clinician told you that you have migraine, not cluster headache (use our migraine visit).
• If more than one fits, follow the first one.