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What are the symptoms of Cluster Headaches
Diagnostic Criteria for Cluster Headache
| A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 minutes (when untreated) ∗C. Either or both of the following:1. At least one of the following symptoms or signs, ipsilateral to the headache:a. Conjunctival injection and/or lacrimationb. Nasal congestion and/or rhinorrheac. Eyelid edemad. Forehead and facial sweatinge. Forehead and facial flushingf. Sensation of fullness in the earg. Miosis and/or ptosis2. A sense of restlessness or agitation D. Attacks have a frequency between one every other day and eight per day for more than half of the time when the disorder is active E. Not better accounted for by another ICHD-3 diagnosis |
During part (but less than half) of the time course of cluster headache, attacks may be less severe and/or of shorter or longer duration.
The strictly unilateral pain is behind the eye in about 90%, over the temple in 70%, and over the maxilla in 50% although the pain may be in the occipital neck region.
The pain is usually severe in intensity and is sharp, stabbing, piercing, burning, or pulsating in quality.
Most have one to three attacks per day. About 15% report that the pain shifts sides between bouts of attacks and, less often, during a bout, but never during a single attack.
Untreated, each headache lasts 15 to 180 minutes, during which patients usually are either restless or agitated and prefer to pace, rock back and forth, or bang their heads. Nocturnal attacks occur in 70%.
Migrainous symptoms of light and noise sensitivity are reported by 70%, vomiting or nausea in more than 20%, and perhaps 14% report an aura (including visual and paresthesia).
About 97% have ipsilateral cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, ptosis, and miosis.
Sources
Nesbitt AD, Goadsby PJ: Cluster headache. BMJ 344:e2407, 2012.
