Cluster tic syndrome (CTS) is a disorder characterized by three types of pain attacks. One resembles trigeminal neuralgia, the second resembles cluster headache, and the third is mixed, starting as a neuralgic pain immediately followed by a homolateral headache accompanied by autonomic signs. This type of attack is pathognomonic for CTS. The three pain types can all be provoked. CTS appears between ages 20 and 70 and may be either episodic or chronic; medical treatment is poor.