Headaches: Cluster - Managing Cluster Headaches

Diagnosis

Many patients report a delay of 1 - 6 years in the diagnosis of their cluster headaches. Migraine-like symptoms (light and sound sensitivity, aura, nausea, vomiting) are major reasons for the frequent misdiagnosis by primary care doctors. In some cases, patients are inappropriately treated for other types of headaches or health conditions (including having sinus surgery).

Medical and Personal History

Cluster headache is diagnosed by medical history, including the pattern of recurrent attacks, and by typical symptoms (swollen eyelid, watery eye, runny nose). Keeping a headache diary to record a description of attacks can help the doctor make an accurate diagnosis. The patient should describe to the doctor:

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• Frequency of attacks (if keeping a diary, record the date and time of each attack)
• Description of pain (stabbing, throbbing)
• Location of pain
• Duration of pain
• Intensity of pain (using a number scale like the one below)
• Associated symptoms (tearing eyes, nausea and vomiting, sweating)
• Any measures that bring relief (applying pressure, going out for fresh air)
• Any events that preceded or may have triggered the attack
• Any medications you are taking
• Behaviors during a headache (restlessness, agitation)
• Snoring, sleep disturbances, or daytime sleepiness (these could relate to sleep apnea, which is sometimes associated with cluster headache)

Pain may be indicated by using a number system:

1 = Mild, barely noticeable

2 = Noticeable, but does not interfere with work or activities

3 = Distracts from work or activities

4 = Makes work or activities very difficult

5 = Incapacitating

Physical Examination

To diagnose a chronic headache, the doctor will examine the head and neck and perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, and sensation. The doctor may also examine the eyes. The doctor may ask questions to test short-term memory and related aspects of mental function.

Imaging Tests

The doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) test of the head to check for brain abnormalities that may be causing the headaches.

Ruling Out Other Headaches and Medical Disorders

As part of the diagnosis, a doctor should rule out other headaches and disorders. If the results of the history and physical examination suggest other or accompanying causes of headaches or serious complications, extensive imaging tests are performed.

Migraines. Cluster headaches are often misdiagnosed as migraines but they are quite different: