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
Risk factors
- male sex
- family history
- head injury
- cigarette smoking
- heavy drinking
Diagnostic investigations
1st investigations to order
- brain MRI without and with intravenous contrast
- erythrocyte sedimentation rate
- pituitary function tests
Investigations to consider
- brain CT scan
- polysomnogram
- ECG
Treatment algorithm
acute attack: without cardiovascular disease or uncontrolled hypertension
acute attack: with cardiovascular disease or uncontrolled hypertension
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.
Differentials
- Migraine
- Paroxysmal hemicrania
- Short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
More DifferentialsGuidelines
- Headaches in over 12s: diagnosis and management
- ACR Appropriateness Criteria: headache
More GuidelinesPatient leaflets
Cluster headaches: what are they?
Cluster headaches: what treatments are available?
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