Cluster Headache Clinical Presentation

  • Author: Ragasri Kumar, DO; Chief Editor: Howard A Crystal, MD   more...
 
Updated: Jun 22, 2011
 

History

  • Attacks of cluster headache (CH) are typically short in duration (5-180 min) and occur with a frequency from once every other day to 8 times a day, particularly during sleep or early morning hours, usually corresponding with onset of REM sleep.[3] As opposed to migraine, CH is not preceded by aura and is not usually associated with accompanying symptoms such as nausea, vomiting, photophobia, or osmophobia. Typically, a cluster lasts 2 weeks to 3 months.
  • Pain is described as excruciating, stabbing, sharp, and lancinating, rather than throbbing. The pain is unilateral, in the periorbital, retroorbital, or temporal regions. Sometimes, the pain radiates to the cheek, jaw, occipital, and nuchal regions. CH may rarely switch sides.
  • Pain is accompanied by cranial parasympathetic symptoms including ipsilateral lacrimation, conjunctival injection, rhinorrhea, eyelid edema, ptosis, and miosis.[3]
  • Alcoholic products and tobacco may precipitate an attack.
  • Some triggers include hot weather, watching television, nitroglycerin, stress, relaxation, extreme temperatures, glare, allergic rhinitis, and sexual activity.
  • During an attack of CH, patients may become agitated and extremely restless. Patients do not like to lie down to rest; instead, they are restless and prefer to pace or move around. In desperation, patients may rock, sit, pace, bang themselves against a hard surface, scream in pain, or crawl on the floor.
  • Classification of CH: The International Headache Society (IHS) classifies CH by duration as episodic or chronic.[6]
    • Episodic CH occurs in periods lasting from 7 days to 1 year; cluster attacks are separated by pain-free intervals lasting at least 2 weeks.
    • Chronic CH is defined as that occurring for more than 1 year without remission or with remissions lasting less than 2 weeks. It is subdivided into chronic CH from onset and chronic CH evolving from episodic.
  • Structural lesions have been described with CH and should be suspected if the presentation is atypical. Atypical features may include the following:
    • Absence of a periodic pattern
    • Residual headache between exacerbations
    • Bilaterality
    • Incomplete or minimal response to standard therapy
    • Presence of lateralizing findings on examination (other than Horner syndrome)
  • Patients with CH have increased risk of suicide attempts, alcohol use, cigarette smoking, and peptic ulcer disease.
Next

Physical

  • The association of prominent autonomic phenomena is a hallmark of cluster headache (CH). Such signs include ipsilateral nasal congestion and rhinorrhea, lacrimation, conjunctival hyperemia, facial diaphoresis, palpebral edema, and complete or partial Horner syndrome (which may persist between attacks). Tachycardia is a frequent finding.
  • A distinctive CH face is described as follows: leonine facial appearance, multifurrowed and thickened skin with prominent folds, a broad chin, vertical forehead creases, and nasal telangiectasias.
Previous
Next

Causes

  • The exact cause of cluster headache (CH) is unknown.
  • The disorder is sporadic, although rare cases of an autosomal dominant pattern within a single family have been reported.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Ragasri Kumar, DO  Resident Physician, Department of Neurology, Loyola University Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Rima M Dafer, MD, MPH, FAHA  Associate Professor, Department of Neurology and Neurological Surgery, Loyola University, Chicago Stritch School of Medicine

Rima M Dafer, MD, MPH, FAHA is a member of the following medical societies: American Academy of Neurology, American Headache Society, and American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph Carcione Jr, DO, MBA  Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James H Halsey, MD  Professor, Department of Neurology, University of Alabama Medical Center

James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Howard A Crystal, MD  Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center

Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

References

  1. Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol. Aug 2002;1(4):251-7. [Medline].

  2. Holle D, Obermann M, Katsarava Z. The electrophysiology of cluster headache. Curr Pain Headache Rep. Apr 2009;13(2):155-9. [Medline].

  3. Mendizabal JE, Umana E, Zweifler RM. Cluster headache: Horton's cephalalgia revisited. South Med J. Jul 1998;91(7):606-17. [Medline].

  4. Lodi R, Pierangeli G, Tonon C, et al. Study of hypothalamic metabolism in cluster headache by proton MR spectroscopy. Neurology. 2006;66(8):1624-6. [Medline].

  5. Kudrow L. Cluster headache: diagnosis and management. Headache. Apr 1979;19(3):142-50. [Medline].

  6. Mathew NT. Cluster Headache. Neurology. 1992;42 (suppl 2):22-31. [Medline].

  7. Peterlin BL, Levin M, Cohen JA, Ward TN. Secondary cluster headache: a presentation of cerebral thrombosis. Cephalalgia. 2006;26(8):1022-4. [Medline].

  8. Rozen TD. Trigeminal autonomic cephalalgias. Neurol Clin. May 2009;27(2):537-56. [Medline].

  9. Sewell RA. Response of cluster headache to kudzu. Headache. Jan 2009;49(1):98-105. [Medline].

  10. Kano H, Kondziolka D, Mathieu D, et al. Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium. J Neurosurg. Jun 2011;114(6):1736-43. [Medline].

  11. Ailani J, Young WB. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Curr Pain Headache Rep. Apr 2009;13(2):164-7. [Medline].

  12. Franzini A, Ferroli P, Leone M, Broggi G. Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery. May 2003;52(5):1095-9; discussion 1099-101. [Medline].

  13. Leone M, Proietti Cecchini A, Franzini A, et al. Lessons from 8 years' experience of hypothalamic stimulation in cluster headache. Cephalalgia. Jul 2008;28(7):787-97; discussion 798. [Medline].

  14. Leone M, Franzini A, Broggi G, Bussone G. Hypothalamic stimulation for intractable cluster headache. Neurology. 2006;67(1):150-2. [Medline].

  15. May A, Leone M. Update on cluster headache. Curr Opin Neurol. Jun 2003;16(3):333-40. [Medline].

  16. Leone M. Deep brain stimulation in headache. Lancet Neurol. Oct 2006;5(10):873-7. [Medline].

  17. Fontaine D, Lazorthes Y, Mertens P, Blond S, Géraud G, Fabre N. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain. Feb 2010;11(1):23-31. [Medline].

  18. Narouze SN. Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep. Apr 2010;14(2):160-3. [Medline].

  19. Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. Apr 2009;49(4):571-7. [Medline].

  20. Calhoun AH, Peterlin BL. Treatment of cluster headache in pregnancy and lactation. Curr Pain Headache Rep. Apr 2010;14(2):164-73. [Medline].

  21. Giraud P, Chauvet S. Cluster headache during pregnancy: case report and literature review. Headache. Jan 2009;49(1):136-9. [Medline].

  22. Boes CJ, Capobianco DJ, Cutrer FM, Dodick DW, Eross EJ, Swanson JW. Headache and Other Crainofacial Pain. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in Clinical Practice: The Neurological Disorders. Vol 2. 4th ed. Philadelphia, Pa: Butterworth Heinemann; 2004:2090-1.

  23. Ekbom K, Nappi G. Diagnosis, differential diagnosis, and prognosis of cluster headache. In: The Headaches. 1993:585-9.

  24. Lance JW. Headache: Mechanism and Management. 5th ed. Boston, Mass: Butterworth-Heinemann; 1993.

  25. Rozen TD. Trigeminal Autonomic Cephalgias. Neurology Continium. December 2006;12:170-193.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.