Cluster Headache: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate cluster headache:

  • Brief unilateral (one-sided) attacks of headache and/or facial pain (pain in the eye and temple area, on one side of the face only)
    • Pain character: drilling, stabbing.
    • Pain intensity: extremely high
    • Attack duration: 15-180 minutes (untreated)
    • Attack frequency 1 to 8/day
  • Strong urge to move, with pacing back and forth or rocking of head or upper body, during attacks (90%)
  • Concomitant occurrence of at least one of the following characteristics ipsilaterally (on the same side of the face):
    • Red or watery eye (conjunctival redness).
    • Miosis (temporary pupillary constriction) and ptosis (drooping upper eyelid).
    • Eyelid edema
    • Stuffy or runny nose (rhinorrhea/nasal runny and/or nasal congestion).
    • Sweating on the face (rarely also side-different).
  • As pathognomonic (proving a disease) is the pronounced urge to move associated with the attack described!

Further notes

  • * When the frequency and intensity of attacks are high, a continuous pain and ipsilateral (on the same side of the face) Horner’s syndrome (synonym: Horner’s triad); there is mostly ipsilateral symptom complex caused by the failure of the head part of the sympathetic nervous system, and characterized by a typical triad: Miosis (pupillary constriction), ptosis (drooping upper eyelid) and a pseudoenophthalmos (apparently sunken eyeball)) persist throughout.
  • Patients describe symptoms as follows:
    • As if a red-hot knife stabs the eye.
    • As when a burning thorn sits in the temple
  • Cluster headache occurs in about 60% of cases during sleep; often in such cases there is a sleep-related breathing disorder (SBAS).

Warning signs (red flags)