Cluster Headache Symptoms
Cluster headaches present with severe, strictly unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes, accompanied by ipsilateral autonomic symptoms and restlessness or agitation. 1, 2
Pain Characteristics
- Severe to excruciating unilateral pain that is strictly one-sided, located in the orbital (around the eye), supraorbital (above the eye), or temporal region 1, 3, 2
- Duration of 15-180 minutes per attack, distinguishing it from migraine (which lasts 4-72 hours) and tension headaches 1, 2, 4
- Attack frequency ranges from once every other day to eight times daily, with attacks often occurring in clusters or "bouts" 1, 2, 4
Ipsilateral Autonomic Symptoms
The hallmark autonomic features occur on the same side as the pain and include:
- Lacrimation (tearing) - most commonly reported 1, 2, 4
- Conjunctival injection (red eye) 1, 2, 4
- Nasal congestion or rhinorrhea (runny nose) 3, 2, 4
- Ptosis (drooping eyelid) 3, 5, 4
- Miosis (constricted pupil) 3, 5, 4
- Eyelid edema (swelling) 3, 2, 4
- Forehead and facial sweating on the affected side 2, 4
At least one of these autonomic symptoms must be present for diagnosis. 1
Behavioral Features
- Restlessness or agitation during attacks - patients typically pace, rock, or cannot sit still, which contrasts sharply with migraine patients who prefer to lie still in a dark, quiet room 1, 3, 5
Temporal Patterns
- Circadian periodicity - attacks often occur at the same time each day, particularly during the night 3
- Circannual periodicity - attacks cluster in bouts occurring during specific months of the year 3
- Episodic pattern (most common) - bouts last weeks to months with remission periods 3, 6
- Chronic pattern - attacks occur for more than one year without remission periods 6
Common Triggers
- Alcohol is the only consistent dietary trigger during active cluster periods 3, 4
- Strong odors (particularly solvents and cigarette smoke) 3
- Nitroglycerin and foods containing nitrates 4
- Napping or changes in sleep patterns 3
Key Distinguishing Features from Other Headaches
Compared to migraine: Cluster headaches have shorter duration (15-180 minutes vs. 4-72 hours), strictly unilateral pain with autonomic symptoms, and patients are restless rather than still; migraines typically have nausea/vomiting and photophobia/phonophobia 1
Compared to tension headaches: Cluster headaches are unilateral and severe with autonomic features, whereas tension headaches are bilateral, pressing/tightening, mild-to-moderate intensity, and lack autonomic symptoms 7, 1
Clinical Pitfall
The diagnostic delay for cluster headache averages 7 years, with frequent misdiagnosis as migraine or sinusitis. 6 The combination of strictly unilateral severe orbital pain lasting 15-180 minutes with ipsilateral autonomic symptoms and restlessness should immediately suggest cluster headache. 1, 2