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Headache, Cluster

Samuel C. Wang, MD and Anna Sophia Fields, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • A primary headache disorder characterized by circadian and circannual episodes consisting of multiple attacks of severe, unilateral sharp, searing, or piercing pain typically localiz...

DIAGNOSIS

International Classification of Headache Disorders (3rd edition, 2018) criteria 
  • At least five attacks of severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting ...

TREATMENT

Many of the medications discussed are used off-label in the treatment of CH (1). 

GENERAL MEASURES

  • Avoid major changes in sleep habits.

  • Stop smoking.

  • Avoid use of alcohol during cluster period.

  • ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Anticipate cluster bouts and initiate prophylaxis early

  • Monitor for depression and suicidal ideation, especially in those with cCH.

DIET

 Avoid alc...

REFERENCES

1
Diener HC, May A. Drug treatment of cluster headaches. Drugs. 2022;82(1):33-42.
2
Robbins  M, Starling  A, Pringsheim  T, et al. Treatment of cluster headache: the Am...

CODES

ICD10

  • G44.009 Cluster headache syndrome, unspecified, not intractable

  • G44.019 Episodic cluster headache, not intractable

  • G44.029 Chronic cluster headache, not intractable

  • G44.001 Cluster headache sy...

CLINICAL PEARLS

  • Patients are often agitated and restless during acute attacks.

  • High-flow oxygen and triptans, not narcotics, are first-line therapy for acute attacks.

  • Among triptans, injected forms are ...

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