Background and Objectives:Cluster headache is considered a male-dominated disorder, but we have previously suggested that females may display a more severe phenotype. Studies on sex differences in cluster headache have been conflicting, therefore this study, with the largest validated cluster headache material at present, gives more insights into sex-specific characteristics of the disease. The objective with this study was to describe sex differences in patient demographics, clinical phenotype, chronobiology, triggers, treatment, and lifestyle in a Swedish cluster headache population.Methods:Study participants were identified by screening medical records from 2014 – 2020, requested from hospitals and neurology clinics in Sweden for the International Classification of Diseases 10 code G44.0 for cluster headache. Each study participant answered a detailed questionnaire on clinical information and lifestyle and all variables were compared with regards to sex.Results:874 study participants with a verified cluster headache diagnosis were included. 575 (66%) were male and 299 (34%) were female and biological sex matched self-reported sex for all. Females were to a greater extent diagnosed with the chronic cluster headache subtype compared to males (18% vs 9%,P=0.0002). In line with this observation, female participants report longer bouts than male participants (P=0.003) and used prophylactic treatment more often (60% vs 48%,P=0.0005). Regarding associated symptoms, females experienced ptosis (61% vs 47%,P=0.0002) and restlessness (54% vs 46%,P=0.02) more frequently compared to males. More female than male study participants had a positive family history for cluster headache (15% vs 7%,P=0.0002). In addition, females reported diurnal rhythmicity of their attacks more often than males (74% vs 63%,P=0.002). Alcohol as a trigger occurred more frequently in males (54% vs 48%,P=0.01), while lack of sleep triggering an attack was more common in females (31% vs 20%,P=0.001).Discussion:With this in-depth analysis of a well-characterized cluster headache population, we could demonstrate that there are significant differences between males and females with cluster headache which should be regarded at time of diagnosis and when choosing treatment options. The data suggests that females generally may be more gravely affected by cluster headache than males.