Current Pain and Headache Reports

, Volume 6, Issue 1, pp 76–82

Misdiagnosis of cluster headache

  • Lynne O. Geweke


Misdiagnosis of cluster headache is common in clinical practice and can lead to significant morbidity. The International Headache Society has published diagnostic criteria that are generally straightforward and useful, but careful understanding of these criteria and how to handle exceptions is necessary. The primary diagnostic points involve severity, length, and frequency of individual headache attacks, as well as the presence of ipsilateral autonomic features. Such additional features as time cycling of headache clusters, physical characteristics of patients, and response to treatment may prove useful in individual cases, but must not be relied on too much.


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References and Recommended Reading

  1. 1.
    Klapper JA, Klapper A, Voss T: The misdiagnosis of cluster headache: a nonclinic, population-based, Internet survey. Headache 2000, 40:730–735. This survey using Internet resources illuminates the difficulty cluster headache sufferers have had in obtaining accurate diagnosis, as well as the misplaced use of diagnostic resources and treatments common in this disorder.PubMedCrossRefGoogle Scholar
  2. 2.
    Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society [no authors listed]. Cephalalgia 1988, 8:1–96.Google Scholar
  3. 3.
    Torelli P, Cologno D, Cademartiri C, Manzoni GC: Application of the International Headache Society classification criteria in 652 cluster headache patients. Cephalalgia 2001, 21:145–150. The authors review the signs and symptoms of a large number of their clinic patients thought to have cluster headache, and compare them with the IHS diagnostic criteria. Although there is a certain amount of circular reasoning involved in such an endeavor, the result is an illuminating picture of a cluster headache population.PubMedCrossRefGoogle Scholar
  4. 4.
    Kunkle EC, Pfeiffer JB, Wilhoit WM, Hamrick LW: Recurrent brief headaches in "cluster" pattern. Trans Am Neurol Assoc 1952, 77:240–243.Google Scholar
  5. 5.
    Rasmussen BK: Epidemiology of cluster headache. In Cluster Headache and Related Conditions. Edited by Olesen J, Goadsby PJ. Oxford: Oxford University Press; 1999:23–26. The book is a multi-authored set of research papers on cluster headache. It includes good information on the trigeminalautonomic cephalgias.Google Scholar
  6. 6.
    Russell D: Cluster headache: severity and temporal profiles of attacks and patients’ activity prior to and during attacks. Cephalalgia 1981, 1:209–216.PubMedCrossRefGoogle Scholar
  7. 7.
    Ekbom K: A clinical comparison of cluster headache and migraine. Acta Neurol Scand 1970, suppl 41:1–48.Google Scholar
  8. 8.
    Dodick DW, Rozen TD, Goadsby PJ, Silberstein SD: Cluster headache. Cephalalgia 2000, 20:787–803. A recent, well-written, and thorough review of cluster headache in its clinical presentation, treatment, and putative pathophysiology.PubMedCrossRefGoogle Scholar
  9. 9.
    Lance JW, Anthony M: Migrainous neuralgia or cluster headache. J Neurol Sci 1971, 13:401–414.PubMedCrossRefGoogle Scholar
  10. 10.
    Ekbom K: Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society. Cephalalgia 1990, 10:195–197.PubMedCrossRefGoogle Scholar
  11. 11.
    Nappi G, Micieli G, Cavallini A, et al.: Accompanying symptoms of cluster attacks: their relevance to the diagnostic criteria. Cephalalgia 1992, 12:165–168.PubMedCrossRefGoogle Scholar
  12. 12.
    Manzoni GC: Male preponderance of cluster headache is progressively decreasing over the years. Headache 1997, 37:588–589.PubMedCrossRefGoogle Scholar
  13. 13.
    Manzoni GC: Gender ratio of cluster headache over the years: a possible role of changes in lifestyle. Cephalalgia 1998, 18:138–142.PubMedCrossRefGoogle Scholar
  14. 14.
    Rozen TD, Niknam RM, Shechter AL, et al.: Cluster headache in women: clinical characteristics and comparison with cluster headache in men. J Neurol Neurosurg Psychiatry 2001, 70:613–617. In comparing the characteristics of male versus female cluster headache patients, the authors have also nicely elaborated on the clinical picture of cluster headache in general.PubMedCrossRefGoogle Scholar
  15. 15.
    Graham JR: Cluster headache. Headache 1972, 11:175–185.PubMedCrossRefGoogle Scholar
  16. 16.
    Kudrow L: Cluster headache: diagnosis and management. Headache 1979, 19:142–150.PubMedCrossRefGoogle Scholar
  17. 17.
    Cuypers J, Attenkirch H, Bunge S: Personality profile in cluster headache and migraine. Headache 1981, 21:21–24.PubMedCrossRefGoogle Scholar
  18. 18.
    Manzoni GC, Terzano MG, Bono G, et al.: Cluster headache: clinical findings in 180 patients. Cephalalgia 1981, 3:21–30.CrossRefGoogle Scholar
  19. 19.
    Ekbom K, Solomon S: Management of cluster headache. In The Headaches, edn 2. Edited by Olesen J et al. Philadelphia: Lippincott Williams & Wilkins; 2000:731–740. The book is a new edition of a classic, and provides exhaustive treatment of headaches and head pains of all sorts.Google Scholar
  20. 20.
    Blau JN: Behaviour during a cluster headache. Lancet 1993, 342:723–725.PubMedCrossRefGoogle Scholar
  21. 21.
    Kudrow L: Response of cluster headache attacks to oxygen inhalation. Headache 1981, 21:1–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Fogan L: Treatment of cluster headache. A double-blind comparison of oxygen vs. air inhalation. Arch Neurol 1985, 42:362–363.PubMedGoogle Scholar
  23. 23.
    Ekbom K: Treatment of acute cluster headache with sumatriptan. N Engl J Med 1991, 325:322–326.CrossRefGoogle Scholar
  24. 24.
    Goadsby PJ, Lipton RB: A review of paroxysmal hemicranias, SUNCT syndrome, and other short-lasting headaches with autonomic feature, including new cases. Brain 1997, 120:193–209.PubMedCrossRefGoogle Scholar
  25. 25.
    Fanciullacci M, Alessandri M, Sicuteri R, Marabini S: Responsiveness of the trigeminovascular system to nitroglycerin in cluster headache patients. Brain 1997, 120:283–288.PubMedCrossRefGoogle Scholar
  26. 26.
    Ekbom K: Nitroglycerin as a provocative agent in cluster headache. Arch Neurol 1968, 19:487–493.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Lynne O. Geweke
    • 1
  1. 1.Department of NeurologyUniversity of IowaIowa CityUSA

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