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• A cluster headache is almost always one-sided and patients will typically experience cluster headache always on the same side of the head, regardless of how many years they have suffered with them. In approximately 14-18% of patients, headaches switch sides during a cluster cycle or in subsequent cycles.
• Pain has been described as boring, spike-like, "like a hot poker", unremitting or throbbing - it is always severe.
• Some patients report icepick, stabbing-like pains in and around the eye that last for a few seconds and may occur in rapid succession.
• Cluster headache pain typically occurs behind or around the eye, and/or in the area of the temple, but the pain can also radiate to the forehead, cheek and/or nose.
• Some patients experience base of the neck pain during an attack.
• Each headache typically reaches maximum intensity within 15 minutes and can last anywhere from 15 minutes to 3 hours (average 45-60 minutes).
• Patients typically have between 1 and 3 headaches per day, but rarely more than 5-8 per day. In between the headache episodes, the patient can be pain free or have a mild dull ache on the same side of the head.
• Many cluster patients awaken from sleep with a headache (some believe these are the most severe headaches) usually within 90 minutes after falling asleep. This coincides with the first dream sleep period (REM sleep) of the evening. Because of this, some patients report being afraid to go to sleep at night.
• Typically there is a rapid increase of heart rate at the onset of an attack and then the patient may experience bradycardia (slowing of the heart rate).
• Sometimes, an individual can feel a pulsing artery in the neck.
• Cluster headaches are not typically associated with nausea, vomiting, or reports of an aura, but their presence should not rule out a diagnosis of cluster headache.
• The intensity of the headache usually causes significant agitation or restlessness in the individual during which they may try anything to alleviate the pain or distract themselves from the pain (e.g., pace back and forth or bang their heads on a hard surface). Rarely can a cluster headache patient sit still during a headache. Many patients become aggressive during a cluster headache attack.

Autonomic symptoms almost always occur on the same side of the face as the pain from the cluster attack. These symptoms may be absent in up to 3% of individuals with cluster headache. Autonomic symptoms may include:

• Lacrimation - tearing of the eye
• Conjunctival injection - reddening of the eye
• Nasal congestion
• Rhinorrhea - runny nose
• Forehead/facial sweating
• Miosis - contraction of the pupil
• Ptosis - drooping of the eyelid
• Swelling of the eyelid

In some patient, miosis and ptosis may persist between cluster attacks but intensify when a new attack begins. Cluster patients can also have migraine-like symptoms, (e.g., light and sound sensitivity, nausea, vomiting).

Some patients report feeling subtle changes when an attack is imminent, including:

• Excessive sweating
• Feeling of discomfort
• One-sided mild sense of burning