Approach Considerations

The diagnosis of cluster headache (CH) is based on historical and physical findings. A history of attacks that occur with the characteristic periodicity and rhythmicity is the key to the diagnosis. Laboratory studies are not of particular value in this regard.

Imaging studies, though not diagnostic, are useful for excluding other potential causes of headache in selected patients. Neuroimaging with assessment of the intracranial and cervical vasculature and the sellar and paranasal region is recommended in all patients with atypical presentations of trigeminal autonomic headaches.

Treatment & Management

Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol. 2002 Aug. 1(4):251-7. [Medline].
Matharu M. Cluster headache. Clin Evid (Online). 2010 Feb 9. 2010:[Medline]. [Full Text].
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan. 38 (1):1-211. [Medline].
Holle D, Obermann M, Katsarava Z. The electrophysiology of cluster headache. Curr Pain Headache Rep. 2009 Apr. 13(2):155-9. [Medline].
Mendizabal JE, Umana E, Zweifler RM. Cluster headache: Horton's cephalalgia revisited. South Med J. 1998 Jul. 91(7):606-17. [Medline].
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].
Kudrow L. Cluster headache: diagnosis and management. Headache. 1979 Apr. 19(3):142-50. [Medline].
Torelli P, Beghi E, Manzoni GC. Cluster headache prevalence in the Italian general population. Neurology. 2005 Feb 8. 64 (3):469-74. [Medline].
Ekbom K, Ahlborg B, Schéle R. Prevalence of migraine and cluster headache in Swedish men of 18. Headache. 1978 Mar. 18 (1):9-19. [Medline].
Lin KH, Wang PJ, Fuh JL, Lu SR, Chung CT, Tsou HK, et al. Cluster headache in the Taiwanese -- a clinic-based study. Cephalalgia. 2004 Aug. 24 (8):631-8. [Medline].
Sjaastad O, Bakketeig LS. Cluster headache prevalence. Vågå study of headache epidemiology. Cephalalgia. 2003 Sep. 23 (7):528-33. [Medline].
Rozen TD, Fishman RS. Female cluster headache in the United States of America: what are the gender differences? Results from the United States Cluster Headache Survey. J Neurol Sci. 2012 Jun 15. 317(1-2):17-28. [Medline].
Barloese MC, Jennum PJ, Lund NT, Jensen RH. Sleep in cluster headache - beyond a temporal rapid eye movement relationship?. Eur J Neurol. 2015 Apr. 22 (4):656-e40. [Medline].
Peterlin BL, Levin M, Cohen JA, Ward TN. Secondary cluster headache: a presentation of cerebral thrombosis. Cephalalgia. 2006. 26(8):1022-4. [Medline].
Rozen TD. Trigeminal autonomic cephalalgias. Neurol Clin. 2009 May. 27(2):537-56. [Medline].
Sewell RA. Response of cluster headache to kudzu. Headache. 2009 Jan. 49(1):98-105. [Medline].
Martinez J, et al. Study CGAL: A phase 3 placebo-controlled study of galcanezumab in patients with episodic cluster headache: Results from the 8-week double-blind treatment phase (abstract IOR03LB). Presented at the 60th American Headache Society Annual Meeting. San Francisco, CA. June 28, 2018.
[Guideline] Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct. 52(4):407-36. [Medline].
[Guideline] Biondi D, Mendes P. Treatment of primary headache: cluster headache. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation. 2004. [Full Text].
[Guideline] Beithon J, Gallenberg M, Johnson K, et al. Diagnosis and Treatment of Headache. Institute for Clinical Systems Improvement. Available at http://bit.ly/Headache0113. Accessed: March 31, 2014.
Calhoun AH, Peterlin BL. Treatment of cluster headache in pregnancy and lactation. Curr Pain Headache Rep. 2010 Apr. 14(2):164-73. [Medline].
Giraud P, Chauvet S. Cluster headache during pregnancy: case report and literature review. Headache. 2009 Jan. 49(1):136-9. [Medline].
Tfelt-Hansen P. Acute pharmacotherapy of migraine, tension-type headache, and cluster headache. J Headache Pain. 2007 Apr. 8(2):127-34. [Medline].
Beck E, Sieber WJ, Trejo R. Management of cluster headache. Am Fam Physician. 2005 Feb 15. 71(4):717-24. [Medline].
Pageler L, Limmroth V. Oral triptans in the preventive management of cluster headache. Curr Pain Headache Rep. 2012 Apr. 16(2):180-4. [Medline].
Stochino ME, Deidda A, Asuni C, Cherchi A, Manchia M, Del Zompo M. Evaluation of lithium response in episodic cluster headache: a retrospective case series. Headache. 2012 Jul-Aug. 52(7):1171-5. [Medline].
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. 2011 Jun. 114(6):1736-43. [Medline].
Ailani J, Young WB. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Curr Pain Headache Rep. 2009 Apr. 13(2):164-7. [Medline].
Gantenbein AR, Lutz NJ, Riederer F, Sándor PS. Efficacy and safety of 121 injections of the greater occipital nerve in episodic and chronic cluster headache. Cephalalgia. 2012 Jun. 32(8):630-4. [Medline].
Franzini A, Ferroli P, Leone M, Broggi G. Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery. 2003 May. 52(5):1095-9; discussion 1099-101. [Medline].
Leone M, Proietti Cecchini A, Franzini A, et al. Lessons from 8 years' experience of hypothalamic stimulation in cluster headache. Cephalalgia. 2008 Jul. 28(7):787-97; discussion 798. [Medline].
Leone M, Franzini A, Broggi G, Bussone G. Hypothalamic stimulation for intractable cluster headache. Neurology. 2006. 67(1):150-2. [Medline].
May A, Leone M. Update on cluster headache. Curr Opin Neurol. 2003 Jun. 16(3):333-40. [Medline].
Leone M. Deep brain stimulation in headache. Lancet Neurol. 2006 Oct. 5(10):873-7. [Medline].
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. 2010 Feb. 11(1):23-31. [Medline].
Narouze SN. Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep. 2010 Apr. 14(2):160-3. [Medline].
Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 2009 Apr. 49(4):571-7. [Medline].
Brauser, D. FDA Approves Vagus Nerve Stimulation Device for Cluster Headache. Medscape Medical News. Available at http://www.medscape.com/viewarticle/878763. April 18, 2017; Accessed: April 26, 2017.
Silberstein SD, Mechtler LL, Kudrow DB, Calhoun AH, McClure C, Saper JR, et al. Non-Invasive Vagus Nerve Stimulation for the ACute Treatment of Cluster Headache: Findings From the Randomized, Double-Blind, Sham-Controlled ACT1 Study. Headache. 2016 Sep. 56 (8):1317-32. [Medline].
Jürgens TP, Gaul C, Lindwurm A, et al. Impairment in episodic and chronic cluster headache. Cephalalgia. 2011 Apr. 31(6):671-82. [Medline].
Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. 2012 Jan. 52(1):99-113. [Medline].

Media Gallery

Cluster headache: Functional imaging shows activation of specific brain areas during pain. Courtesy of Wikipedia Commons.
Cluster headache (CH): Voxel-based morphometry (VBM) structural imaging shows specific brain area of CH patients' (hypothalamus) being different to non-CH patients' brains. Courtesy of Wikipedia Commons.
Non-rebreather oxygen mask with reservoir for the acute treatment of cluster headache. Courtesy of Wikipedia Commons.

of 3

Author

Michelle Blanda, MD Chair Emeritus, Department of Emergency Medicine, Summa Health System Akron City/St Thomas Hospital; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

Michelle Blanda, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Rima M Dafer, MD, MPH, FAHA Associate Professor, Department of Neurological Sciences, Rush Medical College of Rush University Medical Center

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: AMGEN, ELI LILLY<br/>Received research grant from: ELI LILLY<br/>Received income in an amount equal to or greater than $250 from: AMGEN, ELI LILLY.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Acknowledgements

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