Materiały źródłowe

• #1 Cluster Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544241/

  Cluster headaches are the most common of the primary headache type known as trigeminal autonomic cephalgia. […] This activity reviews the evaluation, treatment, and management of cluster headaches, including recognizing other forms of headache. […] Review the specific diagnostic criteria of a cluster headache, including the staging. […] The diagnosis is clinical. […] According to the International Classification of Headache Disorders, 3 edition (ICHD-3), diagnostic criteria for cluster headaches require all of a set of criteria. […] Diagnostic criteria for episodic cluster headache: Attacks fulfill the criteria for cluster headache (as above) and occur in bouts (cluster periods). […] Diagnostic criteria for chronic cluster headache: Attacks fulfill the criteria for cluster headache.

• #2 Cluster headaches

  https://www.nhs.uk/conditions/cluster-headaches/

  Cluster headaches are severe headaches that can happen multiple times a day and continue for weeks or months. […] There are no specific tests to diagnose cluster headaches. A GP will ask you about the pain, location and frequency of your headaches. Theyll also ask about any other symptoms youre having. […] Other conditions can have similar symptoms to cluster headaches. A GP may refer you to a specialist for a brain scan to rule out other possible causes of your symptoms.

• #3 3.1 Cluster headache – ICHD-3

  https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/

  Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 minutes and occurring from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation. […] Diagnostic criteria: At least five attacks fulfilling criteria B-D. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated). Either or both of the following: at least one of the following symptoms or signs, ipsilateral to the headache: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhoea, eyelid oedema, forehead and facial sweating, miosis and/or ptosis. A sense of restlessness or agitation. Occurring with a frequency between one every other day and 8 per day. Not better accounted for by another ICHD-3 diagnosis.

• #4 Cluster Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK544241/

  Cluster headaches are the most common of the primary headache type known as trigeminal autonomic cephalgia. […] This activity reviews the evaluation, treatment, and management of cluster headaches, including recognizing other forms of headache. […] Review the specific diagnostic criteria of a cluster headache, including the staging. […] The diagnosis is clinical. […] A questionnaire asking about headache duration (less than 180 minutes) and autonomic symptoms (conjunctival injection or lacrimation) has a sensitivity of 81% and a specificity of 100%. […] According to the International Classification of Headache Disorders, 3 edition (ICHD-3), diagnostic criteria for cluster headaches require all of a set of criteria. […] These are: At least five attacks; Attacks characterized by severe supraorbital, unilateral orbital, and/or temporal pain lasting 15 to 180 minutes when untreated; during part (but less than half) of the time-course of cluster headache, attacks may be less severe and/or of shorter or longer in duration; Either one or both of the following: At least one of the following signs/symptoms ipsilateral to the headache: Conjunctival injection and/or lacrimation; Forehead and facial sweating; Nasal congestion and/or rhinorrhea; Eyelid edema; Miosis and/or ptosis; A sense of agitation or restlessness; Attacks have a frequency between one every other day and eight per day; during part (but less than half) of the active time-course of headache, attacks may be less frequent; Not better explained by another ICHD-3 diagnosis.

• #5 Pulsenotes | Cluster headache

  https://app.pulsenotes.com/medicine/neurology/notes/cluster-headache

  Cluster headaches have been defined in the International Classification of Headache Disorders 3rd edition (ICHD-3). […] Cluster headaches are described in the ICHD-3 as: 'Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 minutes and occurring from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation.’ […] The following diagnostic criteria are given: At least five attacks fulfilling criteria B-D, Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated), Either or both of the following: at least one of the following symptoms or signs, ipsilateral to the headache: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhoea, eyelid oedema, forehead and facial sweating, miosis and/or ptosis, a sense of restlessness or agitation, Occurring with a frequency between one every other day and 8 per day, Not better accounted for by another ICHD-3 diagnosis.

• #5 Pulsenotes | Cluster headache

  https://app.pulsenotes.com/medicine/neurology/notes/cluster-headache

  Cluster headaches can be further classified into two subtypes: Episodic: refers to patients where multiple attacks occur within periods lasting 7 days to 1 year but with pain-free intervals of at least 3 months between bouts. This is the more common form accounting for 80-90% of cases. Chronic: attacks occurring over a period of 1 year or longer without a period of remission greater than 3 months. This accounts for around 10-20% of cases. […] Patients presenting with their first bout of a cluster-like headache should be referred to neurology for further review. […] TACs and cluster headaches are relatively uncommon and all patients should receive a specialist neurology review to confirm the diagnosis.

• #6 Cluster Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK544241/

  Diagnostic criteria for episodic cluster headache: Attacks fulfill the criteria for cluster headache (as above) and occur in bouts (cluster periods); At least two cluster periods last from 7 days to one year (when untreated), separated by pain-free remission intervals of at least three months. […] Diagnostic criteria for chronic cluster headache: Attacks fulfill the criteria for cluster headache; Attacks occur without a remission period, or with remissions lasting less than three months, for a minimum of 1 year. […] Patients should have magnetic resonance imaging (MRI), or computed tomography (CT) of the head with contrast as an alternative, to rule out any structural abnormality.

• #7 Cluster Headache – Diagnosis and Treatment – touchNEUROLOGY

  https://touchneurology.com/headache-disorders/journal-articles/cluster-headache-diagnosis-and-treatment/

  A cluster headache is defined as an individual attack of head pain, while a cluster period or cycle is the time that a patient is having daily cluster headaches. […] Episodic cluster headache (the most common form) is defined by a cluster period lasting seven days to one year separated by a pain-free period lasting one month or longer. […] Chronic cluster headache is defined by attacks that occur for greater than one year without remission or with remissions lasting less than one month. […] Cluster headache is marked by its associated autonomic symptoms that typically occur on the same side as the head pain but can be bilateral. […] The occurrence of so called migrainous symptoms in cluster has probably led to the high rate of misdiagnosis of cluster patients. […] Cluster headache is really a state of agitation as remaining motionless appears to make the pain worse.

• #7 Cluster Headache – Diagnosis and Treatment – touchNEUROLOGY

  https://touchneurology.com/headache-disorders/journal-articles/cluster-headache-diagnosis-and-treatment/

  Cluster headache is a primary headache syndrome that is under-diagnosed and in many instances undertreated. […] Cluster headache is very stereotyped in its presentation and is fairly easy to diagnose with an in-depth headache history. […] Recently, Klapper et al. determined that the average time it takes for a cluster sufferer to be diagnosed correctly by the medical profession is 6.6 years. […] The average number of physicians seen prior to a correct diagnosis is four and the average number of incorrect diagnoses before a correct diagnosis of cluster is four. […] This statistic is unacceptable based on the pain and suffering cluster patients must endure when they are not treated correctly or when not being treated at all. […] Cluster is a stereotypic episodic headache disorder marked by frequent attacks of short-lasting, severe, unilateral head pain with associated autonomic symptoms.

• #8 3.1.1 Episodic cluster headache – ICHD-3

  https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/3-1-1-episodic-cluster-headache/

  Cluster headache attacks occurring in periods lasting from 7 days to one year, separated by pain-free periods lasting at least 3 months. […] Diagnostic criteria: […] Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) […] At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. […] Cluster periods usually last between 2 weeks and 3 months.

• #9 Cluster headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084

  Cluster headache has a certain type of pain and pattern of attacks. A diagnosis depends on describing the pain, where the pain is, how bad it is and other symptoms. How often headaches come and how long they last also are important. […] For cluster headache, a specialist trained in treating headaches (neurologist) makes a diagnosis on medical history, symptoms, and a physical and neurological examination. […] For people with unusual or complicated headaches, tests to rule out other causes for the pain might include: […] An MRI scan. A magnetic resonance imaging (MRI) scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system conditions. Conditions that affect the brain and nervous system are also known as neurological conditions. […] A CT scan. A computerized tomography (CT) scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.

• #10 Cluster Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5003-cluster-headaches

  A healthcare provider (a neurologist) will diagnose a cluster headache after a physical exam. Theyll want to know more about your symptoms and your medical history. A provider may offer an imaging test, like an MRI, to rule out conditions with similar symptoms. If youre experiencing attacks, it can help your provider learn more about your symptoms as they happen. Your provider might request an exam during the time when your headaches happen each day to observe how the headaches affect you. […] Cluster headache treatment options may include: Medications to prevent headaches. Medications to manage pain during an attack. […] If medications dont help, your healthcare provider might suggest surgery. A surgeon may implant a neurostimulator device to send electrical signals to certain nerves in your head to manage your symptoms. Your provider will let you know if surgery is a good option.

• #11 Cluster headache – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – ArrowVisualV1 – Arrow

  https://migrainetrust.org/understand-migraine/types-of-migraine/other-headache-disorders/cluster-headache/

  Diagnosing cluster headache […] There is no test for cluster headache. Usually a doctor will make a diagnosis by: […] asking about symptoms and history of headache. It can be helpful to keep a headache diary detailing symptoms. […] performing a neurological examination. […] sending people for further tests including a brain scan to rule out a secondary cause […] People with cluster headache are often referred to a consultant neurologist or headache specialist for review and treatment.

• #12 Cluster headache causes, symptoms, & treatment – TeleMed2U

  https://www.telemed2u.com/neurology/cluster-headaches

  Diagnosis starts by describing symptoms to your doctor, including how long the headaches last, any patterns of when they occur, and the pains severity. […] It’s extremely helpful to keep a headache diary noting the date (to help establish patterns), length, intensity, and if you have any pre-headache signs such as an aura. Share this information about each attack with your doctor. […] Cluster headaches are often misdiagnosed as migraine headaches. Because there’s been less research on cluster headaches, many doctors try to treat cluster headaches with medications that help migraines. These are two very different headache conditions, and migraine treatment will not provide successful cluster headache treatment. Treatment must be based on an accurate diagnosis of cluster headache. Misdiagnosis can delay a correct diagnosis for years.

• #13 Cluster Headaches | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cluster-headaches

  Cluster headaches are characterized by a specific type of pain and pattern of attacks. […] Keeping a headache journal is a great way to track the location, severity and duration of pain; medications; and possible headache triggers. […] A physical exam may help your doctor detect signs of a cluster headache. One of your pupils may appear smaller than the other or your eyelid may droop. […] If your doctor suspects a tumor or aneurysm, he or she may order one or more of the following tests: […] Computerized tomography (CT) scan. A CT scan uses a thin X-ray beam that rotates around the area being examined. A computer processes data to construct a 3-D, cross-sectional image. […] Magnetic resonance imaging (MRI). An MRI uses magnetism, radio waves and computer technology, rather than X-rays, to produce images of your brain. Under the right circumstances, MRI and other imaging procedures allows doctors to actually see how the larger structures in the brain are involved during migraine and headache.

• #14 Cluster Headache Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/1142459-clinical

  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). […] Physical examination findings should be normal, except for certain findings that serve as hallmarks of cluster headache (CH). These accompanying findings are consistent with ipsilateral autonomic features characterized by cranial parasympathetic activation and sympathetic hypofunction. The presence of other abnormalities suggests another etiology for the headache.

• #15 Cluster headache: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000786.htm

  A cluster headache is an uncommon type of headache. […] Your health care provider can diagnose this type of headache by performing a physical exam and asking about your symptoms and medical history. […] If a physical exam is done during an attack, the exam will usually reveal Horner syndrome (one-sided eyelid drooping or a small pupil). These symptoms will not be present at other times. No other nervous system (neurologic) changes will be seen. […] Tests, such as an MRI of the head, may be needed to check for other causes of the headaches.

• #16

  https://journals.lww.com/neur/fulltext/2021/69001/cluster_headache__what_s_new_.17.aspx

  Cluster headache is a highly disabling primary headache disorder which is widely described as the most painful condition a human can experience. […] To provide an overview of the clinical characteristics, epidemiology, risk factors, differential diagnosis, pathophysiology and treatment options of cluster headache, with a focus on recent developments in the field. […] Like all primary headache syndromes, the diagnosis of CH is made clinically based on the patient’s history according to consensus criteria see Table 1. Diagnosis will be aided by observation of an attack or photograph or video of an attack demonstrating cranial autonomic symptoms. Between attacks, neurological examination is usually normal though some patients can have a partial Horner’s syndrome. […] Frequently there is a long diagnostic delay before the diagnosis of CH is made and targeted treatment started, and patients are often not given the correct diagnosis on the first presentation to a healthcare professional.

• #17 Cluster Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544241/

  Patients should have magnetic resonance imaging (MRI), or computed tomography (CT) of the head with contrast as an alternative, to rule out any structural abnormality. […] The average cluster headache patient can take approximately five years to diagnose, often only after visiting several different clinicians. […] Cluster headaches are often confused with migraines.

• #18 Cluster Headache: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p24.html

  Cluster headache is a clinical diagnosis based on the criteria described in Table 1. […] A suggested approach to the evaluation of acute headache is summarized in Figure 1. […] The differential diagnosis of cluster headache includes other trigeminal autonomic cephalgias such as paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms, hemicrania continua, or secondary cluster headache caused by intracranial structural lesions (e.g., pituitary adenoma). […] Neuroimaging with computed tomography or magnetic resonance imaging is not routinely recommended. […] Imaging should be performed in patients with sudden changes in headache features (e.g., sudden onset, frequency, severity, location, worst headache of the patient’s life), presence of neurologic findings (e.g., double vision, blindness, weakness, change in mental status or personality), or systemic illness (e.g., fever, rash).

• #19 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. […] This paper aims to review CH’s recent clinical and pathophysiological findings, diagnosis, and treatment. […] An MRI of the brain is mandatory to exclude secondary etiologies. […] In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. […] The diagnosis of CH is primarily clinical, and neuroimaging studies are indicated in specific cases to rule out secondary headaches. […] Frequently, there is a significant delay in diagnosing CH, which is essential when planning optimal medical management. […] When CH is misdiagnosed, the clinical picture is most confounded as migraine, either because the clinical picture is misinterpreted or because both headache disorders occur as comorbidity, which is then not recognized.

• #20 Cluster headache – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/11

  Cluster headache is the most common trigeminal autonomic cephalalgia. […] Diagnosis is based on International Headache Society International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. […] Key diagnostic factors include repeated attacks of unilateral pain, short duration, excruciating pain, lacrimation, rhinorrhea, and partial Horner syndrome, as well as agitation and restlessness. […] 1st tests to order include brain and pituitary MRI without and with intravenous contrast and erythrocyte sedimentation rate. […] Investigations to avoid include Electroencephalography (EEG). […] Tests to consider include pituitary function tests, magnetic resonance angiography (MRA) head and neck with and without contrast, brain CT scan, polysomnogram, and ECG.

• #21 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  The Erwin test is a tool that identifies patients with CH. […] In summary, an MRI of the brain with contrast is recommended in every patient with CH, an MRI of the sella turcica in suspected pituitary tumors and in patients with suspected cerebrovascular lesions, an angio-MRI or MRI of aortic trunks. […] Atypical features of CH that should alert the clinician are (1) pain attacks being exclusively ocular or retro-ocular, (2) abnormal findings on neurological examination, (3) other headache attacks between those typical of CH, (4) atypical duration of CH, (5) migraine-like symptoms, (6) Horner’s syndrome, and (7) an unexpected frequency of atypical attacks, being the most relevant, in particular cranial nerve disorders, within which ophthalmological signs and symptoms are the most frequent. […] Resistance to standard treatments for CH should increase the suspicion of a secondary origin.

• #22

  https://journals.lww.com/neur/fulltext/2021/69001/cluster_headache__what_s_new_.17.aspx

  Accurate diagnosis is important to determine the optimal treatment. […] The main differential diagnoses of CH are other primary headache disorders, particularly migraine and paroxysmal hemicrania. […] In comparison with CH, migraine attacks are typically longer in duration (longer than four hours) and associated with prominent migrainous features (i.e., nausea and vomiting, photophobia, phonophobia). […] The importance of this diagnosis is that unlike CH, paroxysmal hemicrania responds absolutely to the drug indomethacin. […] Our practice is to perform magnetic resonance imaging (MRI) to exclude secondary causes in all patients who present during the first bout or have atypical features. […] Dedicated pituitary imaging does not need to be routinely organized unless any clinical features of pituitary tumor are present, as the risk of a pituitary tumor in this population does not appear to be higher than the background risk.

• #23 Diagnostic and therapeutic errors in cluster headache: a hospital-based study | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-15-56

  Cluster headache (CH) is a severe, disabling form of headache. Even though CH has a typical clinical picture it seems that its diagnosis is often missed or delayed in clinical practice. […] Misdiagnoses at first consultation were recorded in 77% of the cases: trigeminal neuralgia (22%), migraine without aura (19%), sinusitis (15%), etc. The average diagnostic delay was 5.3 6.4 years and the condition was diagnosed approximately (doctor delay: one year). […] Even though a clear description of the clinical picture of CH has been available since the publication of the first (1988) edition of the International Headache Society (IHS) diagnostic criteria, it seems that the diagnosis of CH is often missed or delayed in clinical practice, and diagnostic and therapeutic errors are frequently reported in the literature.

• #24 Cluster Headache and Other Trigeminal Autonomic Cephalalgias

  https://practicalneurology.com/articles/2023-may-june/cluster-headache-and-other-trigeminal-autonomic-cephalalgias

  A correct and timely identification of CH or its mimics, besides ruling out other differentials, allows clinicians to identify and implement effective treatments and may speed time to relief and remission of severely painful symptoms. […] In The International Classification of Headache Disorders, 3rd edition (ICHD-3), CH is defined as attacks of severe, strictly unilateral pain, which are orbital, supraorbital, temporal, or in any combination of these sites, lasting 15 to 180 minutes and occurring from once every other day to 8 times a day. […] A diagnosis of probable CH is made when all but one diagnostic criterion are met. […] The past 3 decades have seen greater understanding of differences and similarities of CH and CH mimics with other TAC disorders. […] The persistent nature of HC is distinct from the cluster timing of CH and can be a useful diagnostic clue among CH, PH, and SUNHA.

• #25 Cluster headache | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cluster-headache?lang=us

  Cluster headaches are characterized by severe unilateral anterior or lateral headache (frontal, orbital or temporal) 1. […] The main role of imaging in patients with cluster headaches is to exclude secondary causes (especially pituitary lesions) or other causes of a severe headache (see differential diagnosis below) 4. […] Once the typical episodic and recurrent nature of the headaches becomes apparent and the stereotyped pattern of signs and symptoms evident the diagnosis can usually be made with a high degree of certainty. Initially, however, many other causes of a severe headache may be thought of as possible etiologies, including: […] other trigeminal autonomic cephalalgias […] migraine […] reversible cerebral vasoconstriction syndrome […] subarachnoid hemorrhage […] structural lesions (e.g. tumors or hemorrhages)

• #26 Cluster headache – Wikipedia

  https://en.wikipedia.org/wiki/Cluster_headache

  Cluster headache is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s). […] Diagnosis is based on symptoms. […] A detailed oral history aids practitioners in correct differential diagnosis, as there are no confirmatory tests for cluster headache. […] Individuals with cluster headaches typically experience diagnostic delay before correct diagnosis. […] People are often misdiagnosed due to reported neck, tooth, jaw, and sinus symptoms and may unnecessarily endure many years of referral to ear, nose and throat (ENT) specialists for investigation of sinuses; dentists for tooth assessment; chiropractors and manipulative therapists for treatment; or psychiatrists, psychologists, and other medical disciplines before their headaches are correctly diagnosed.

• #27 Cluster headache – Wikipedia

  https://en.wikipedia.org/wiki/Cluster_headache

  Under-recognition of cluster headaches by health care professionals is reflected in consistent findings in Europe and the United States that the average time to diagnosis is around seven years. […] Cluster headache may be misdiagnosed as migraine or sinusitis. […] Correct diagnosis presents a challenge as the first cluster headache attack may present where staff are not trained in the diagnosis of rare or complex chronic disease.

• #28 Cluster Headache: Hastening Diagnosis and Treatment | MDedge

  https://community.the-hospitalist.org/content/cluster-headache-hastening-diagnosis-and-treatment-0

  Cluster headache (CH) is a type of primary headacheone of the headache types encompassed by the term trigeminal autonomic cephalalgia. It is one of the most intense, excruciating headaches a patient can experience, and the diagnosis is often missed or delayed. Only 21% of patients receive a correct diagnosis of CH on first presentation, and the average patient visits three health care providers before the correct diagnosis is made. According to recently published results from the US Cluster Headache Survey, the diagnostic delay for CH averages five years or longer, limiting the patients access to correct treatment. […] Diagnosis of headache relies heavily on the patients clinical history and physical exam. A detailed history should include the initial onset of CH, progression of the condition, and information about any precipitating event(s) and prodromal symptoms. Clinicians should document the pattern of pain by including specific information regarding its location, severity, quality, frequency, and duration. Of considerable value is the patients use of an accurate headache diary, which clinicians should encourage headache patients to maintain; in these, patients should be instructed to record the headache characteristics mentioned.

• #29 Cluster Headache: Hastening Diagnosis and Treatment | MDedge

  https://community.the-hospitalist.org/content/cluster-headache-hastening-diagnosis-and-treatment-0

  Patients who have experienced at least five episodes of these headache symptoms, with severe pain in the specified areas and duration, accompanying autonomic symptoms, specified attack frequency, and symptoms not attributed to another disorder meet the diagnostic criteria for cluster headache given in the second edition of the International Classification of Headache Disorders (ICHD-II, 2004). The ICHD-II criteria, based on clinical and epidemiologic research, are recognized as a consensus guideline that is accepted worldwide to facilitate clinical practice. […] Since, by definition, primary headaches are those without underlying organic causes, diagnostic tests and neuroimaging studies are generally not recommended, especially when the patient history and presentation confirm the required ICHD-II diagnostic criteria. However, neuroimaging is often recommended for a patient with CH or CH-like presentations.

• #30 Cluster headache – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/cluster-headache/

  Diagnosis is based on the patient’s history, in particular on the exact description and timing of the headaches. […] In patients with red flag symptoms for headache, secondary headache should be ruled out using an MRI. […] Clinical diagnosis involves performing a diagnostic workup for headache and ruling out red flag symptoms for headache. […] Apply diagnostic criteria for cluster headaches. […] Consider obtaining an initial MRI head to rule out secondary headaches. […] A diagnosis of cluster headache can be established in the presence of 5 attacks that fulfill criteria 1-4. […] Not better explained by another diagnosis. […] Consider screening for depressive disorders at diagnosis. […] In patients with high-risk headaches, obtain further diagnostics to rule out life-threatening secondary headaches (e.g., SAH, meningitis).

• #31 Cluster Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0715/p122.html

  Cluster headache causes severe unilateral temporal or periorbital pain, lasting 15 to 180 minutes and accompanied by autonomic symptoms in the nose, eyes, and face. […] A questionnaire consisting of the combination of typical headaches lasting less than 180 minutes plus conjunctival injection or lacrimation may be used to screen for cluster headache. […] Because of the location and associated symptoms, cluster headache is classified as a trigeminal autonomic cephalgia in the most recent diagnostic criteria from the International Headache Society. […] In addition to severe unilateral headache, associated diagnostic symptoms can include ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, forehead and facial swelling, miosis, or ptosis. […] A questionnaire combining headache duration of less than 180 minutes and conjunctival injection or lacrimation showed a sensitivity of 81.1% and a specificity of 100% for cluster headache diagnosis, and has been suggested as an effective screening tool.

• #32 Quantitative Cluster Headache Analysis for Neurological Diagnosis Support Using Statistical Classification

  https://www.mdpi.com/2078-2489/11/8/393

  Cluster headache (CH) belongs to the group III of The International Classification of Headaches. It is characterized by attacks of severe pain in the ocular/periocular area accompanied by cranial autonomic signs, including parasympathetic activation and sympathetic hypofunction on the symptomatic side. […] We hypothesized that the presence of visible or subtle color iris changes in both eyes could be used as a quantitative biomarker for screening and early detection of CH. […] This work scrutinizes the scope of an automatic diagnosis-support system for early detection of CH, by using as indicator the error rate provided by a statistical classifier designed to identify the eye (left vs. right) from iris pixels in color images. […] Our results showed that a reduced value for the error rate (lower than 0.25) can be used as CH marker, whereas structural regions of the iris image need to be taken into account. The iris color feature analysis using statistical classification is a potentially useful technique to investigate disorders affecting the autonomous nervous system in CH.

• #33 Quantitative Cluster Headache Analysis for Neurological Diagnosis Support Using Statistical Classification

  https://www.mdpi.com/2078-2489/11/8/393

  In this paper, we analyze the statistical differences in iris color to develop an automatic quantitative CH diagnosis method by a machine learning approach, in particular the support vector classifier (SVC). […] The aim of the SVC is to find the optimal decision boundary based on the maximum margin from the boundary to the training samples of each class. […] The proposed method for quantifying the presence of differences in pigmentation between both eyes uses the components of the color space as features to characterize pixels. […] Hence, the estimation provided by a SVC on the iris pixels of both eyes can be used as a simple biomarker for a given patient. It can support the clinician in determining the CH risk of a patient based on color differences between both eyes: the lower the estimation, the higher the CH risk.

• #34

  https://journals.lww.com/neur/fulltext/2021/69001/cluster_headache__what_s_new_.17.aspx

  Functional imaging studies using positron emission tomography (PET) and functional MRI have shown activation in the ipsilateral hypothalamic grey matter during attacks. […] The management options in CH are divided into acute, preventive, and transitional treatments. […] There is good quality evidence for acute treatment with parenteral triptans and high flow oxygen; transitional treatment with oral corticosteroids and greater occipital nerve blocks including corticosteroids; and preventive treatment with verapamil. […] The most established effective acute treatments for cluster attacks are subcutaneous/intranasal triptans and inhaled high-flow oxygen. […] The most established and well evidenced preventive treatment for CH is verapamil and this should be used as the first line preventive medication.

• #35 Quantitative Cluster Headache Analysis for Neurological Diagnosis Support Using Statistical Classification

  https://www.mdpi.com/2078-2489/11/8/393

  The present work aimed to open the way towards an automatic diagnostic system. As such, it highlighted the scope and limitations of the color as a sole criterion. The method provided encouraging results, and it arises as a possibility to provide clinicians with diagnostic support for the early detection and screening of CH patients with a low-cost system.

• #36 Cluster headache | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-3-20

  Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). […] Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. […] The patient must have had at least five attacks of severe or very severe unilateral orbital or supraorbital and/or temporal pain, lasting 15 to 180 minutes if untreated. […] In the absence of autonomic signs, CH can be diagnosed if a sense of restlessness or agitation is present during the attacks. […] Diagnosis of cluster headache is based on clinical criteria and exclusion of a secondary cause.

• #37 Advances in the Diagnosis & Management of Cluster Headache | UTHealth Neurosciences

  https://med.uth.edu/neurosciences/outcomes-report-2023-2024/advances-in-the-diagnosis-management-of-cluster-headache/

  Cluster headache frequently is described as the most excruciatingly painful of all headache disorders. […] Accurate diagnosis often is delayed for years because the headaches are confused with migraines or trigeminal neuralgia, says neurologist Mark Burish, MD, PhD. […] With these new treatments available, early and accurate diagnosis is important, Burish says.

• #38 Diagnostic and therapeutic errors in cluster headache: a hospital-based study | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-15-56

  The delay in CH diagnosis due to medical misdiagnosis (i.e. the doctor delay, which averaged more than one year in our patients), leading to mismanagement of the disease, remains one of the biggest problems for CH patients. […] Therapeutic errors in CH can be avoided when appropriate drugs are available; these should be prescribed, according to the current international guidelines, by headache specialists or general neurologists, who are, in fact, usually the ones that first diagnose the disease. […] A study on a larger population of CH patients may enhance medical education-based strategies to avoid diagnostic and therapeutic errors in this population.

• #39 Cluster Headache: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5003-cluster-headaches

  Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful or less frequent. […] If you suspect you have cluster headaches, reach out to a healthcare provider to confirm the diagnosis. You dont have to be in the midst of a cluster to see a specialist or get a diagnosis.

• #40 Cluster Headache: Symptoms, Pain Relief Option, and Exploratory Treatments — Migraine Again

  https://www.migraineagain.com/cluster-headache/

  Generally, yes. Some healthcare providers aren’t aware of the features of cluster headache and may misdiagnose it as something to do with the eye or as migraine. It’s worthwhile to work with a healthcare provider who has experience treating this condition to develop a plan of management. […] The first is to seek an accurate diagnosis and aggressive therapy with an effective acute and preventive regimen. Cluster headache is not something that one can live with untreated. It is helpful to understand that multiple different treatment approaches can be used. It is a disease that necessitates an aggressive strategy for management.

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