My profile with migraines/cluster headaches is similar to the OP's.. it started with migraines with aura from as early as I can remember which is about 5 years old, and has gotten progressively worse with each decade. Interestingly it was also in my early 30s that the cluster headaches really took hold, putting me in mortal pain for more days out of the year than I could possibly count. Easily 70% of the time for months on end.

Anti-seizure medications have helped me with the headaches in the past, but the long-term side effects (cognitive etc.) haven't been worth it -- something I never would have guessed, that there could be anything more worth avoiding than the pain of my headaches. I too get the knife behind the eye feeling. I have it right now, am about 3 days into what is looking like a pretty bad one.. resistant. I know they have a few things at the hospital that could help, but having dealt with this totally on my own for the first 30 years of pain (when I was a kid they didn't have anything to recommend, and I didn't realize for a long time that anything had come along), I tend not to reach out for that kind of assistance. I do find Imitrex fairly helpful, about 85% of the time, which makes it worth the try for me. Hasn't helped this one though, I just gotta ride it out.