Which headache is unilateral, orbital, severe with lacrimation, rhinorrhea, and ptosis, typically occurring in clusters lasting 15 minutes to 3 hours?

• A. Migraine
• B. Tension-type
• C. Temporal arteritis
• D. Cluster

Answer: (D)

Cluster headaches are a form of primary headaches defined by intense unilateral pain around the eye or orbit, paired with ipsilateral autonomic symptoms such as tearing, nasal discharge, and ptosis. Attacks occur in bursts or clusters, with multiple episodes happening over a period, and each attack typically lasts from about 15 minutes to 3 hours. The described pattern—unilateral, orbital location, severe intensity, tearing, rhinorrhea, ptosis, and short, repeated episodes in clusters—is the classic presentation.

Other headaches don’t fit as well: migraines are often unilateral but usually pulsating and last longer (several hours to days) and are commonly accompanied by nausea, photophobia, or phonophobia without the consistent autonomic features seen in clusters. Tension-type headaches are generally bilateral, with a pressing or tightening quality and no autonomic symptoms. Temporal arteritis presents in older adults with scalp tenderness, jaw claudication, possible vision changes, and a different temporal pattern, not the concise, circadian cluster of very short attacks.