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• The eye on the affected side may become swollen or droop
• Face may become flushed on the affected side

Unlike migraine headaches during which patients are quiet and do not move, cluster patients become agitated and restless during an attack needing to pace back and forth, or move about, or rock back and forth while holding their heads. Sitting or lying still will worsen the cluster pain. It is not uncommon for patients, in desperation, to hit themselves in the head during a headache or scream out in pain because the headache intensity is so severe.

Some individuals with cluster headaches find relief by doing physical exercise (e.g., sit-ups, push-ups or jogging in-place), while others prefer to be outside in cold or fresh air. Some patients try to avoid falling asleep since cluster headaches occur soon after the onset of REM stage (rapid eye movement) of sleep. The difficulty in this effort lies in the fact that when the individual becomes exhausted and falls asleep, REM sleep occurs much sooner than if well rested and this becomes a trigger for a cluster headache.

During "active" periods, attacks may be triggered by a variety of factors including:

• Alcohol
• Stress
• High altitude
• Air travel
• Nitroglycerin tablets
• Warm weather

It is interesting to note that many cluster patients are heavy alcohol users, but once a cluster period starts, they immediately stop drinking because alcohol can trigger a cluster attack within minutes. During the remission periods, the same behaviors will not trigger a cluster headache.