Cluster headache

Last reviewed: 1 Nov 2022
Last updated: 11 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • repeated attacks of unilateral pain
  • excruciating pain
  • lacrimation, rhinorrhoea, and partial Horner's syndrome
  • agitation
  • nausea, vomiting
  • photophobia, phonophobia
  • migrainous aura
More key diagnostic factors

Risk factors

  • male sex
  • family history
  • head injury
  • cigarette smoking
  • heavy drinking
More risk factors

Diagnostic investigations

1st investigations to order

  • brain MRI without and with intravenous contrast
  • erythrocyte sedimentation rate
  • pituitary function tests
More 1st investigations to order

Investigations to consider

  • brain CT scan
  • polysomnogram
  • ECG
More investigations to consider

Treatment algorithm

ACUTE

acute attack: without cardiovascular disease or uncontrolled hypertension

acute attack: with cardiovascular disease or uncontrolled hypertension

ONGOING

episodic/chronic cluster headache

Contributors

Authors

Sarah Miller, MBBS, BSc, MRCP (Neuro)

Clinical Research Fellow

Headache Group

National Hospital for Neurology and Neurosurgery

London

UK

Disclosures

SM declares that she has received an educational grant from St Jude Medical and Medtronic. SM has received payment for educational presentations from Allergan and Autonomic Technologies, Inc.

Alok Tyagi, MBBS, MD, DNB, MRCP, DM

Consultant Neurologist

Southern General Hospital

Glasgow

UK

Disclosures

AT has been on advisory boards for Allergan and electroCore. AT has received organisational payments from eNeura, Allergan, and electroCore.

Manjit S. Matharu, BSc, MBChB, FRCP

Senior Lecturer and Honorary Consultant Neurologist

Headache Group

National Hospital for Neurology and Neurosurgery

London

UK

Disclosures

MSM serves on the advisory board for Allergan, St Jude Medical, and Medtronic. MSM has received payment for the development of educational presentations from Allergan, MSD, Medtronic, and electroCore.

Acknowledgements

Dr Sarah Miller, Dr Alok Tyagi, and Dr Manjit S. Matharu would like to gratefully acknowledge the assistance of Dr Marc S. Husid and Dr Davis L. Mellick.

Disclosures

MSH and DLM declare that they have no competing interests.

Peer reviewers

Juliana VanderPluym, MD, FRCPC, FAHS

Assistant Professor of Neurology and Consultant

Division of Headache

Mayo Clinic Arizona

Scottsdale

AZ

Disclosures

JVP has received a research grant from Amgen.

Mark W. Green, MD, FAAN

Director of Headache and Pain Medicine

Professor of Neurology, Anesthesiology, and Rehabilitation Medicine

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

MWG declares that he has no competing interests.

Anne Walling, MD

Professor

Family and Community Medicine

University of Kansas School of Medicine

Wichita

KS

Disclosures

AW declares that she has no competing interests.

Christian Lampl, MD, PhD

Department Head

Department of Neurology and Pain Medicine

Konventhospital Barmherzige Brüder Linz

Linz

Austria

Disclosures

CL declares that he has no competing interests.

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