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Headache, Cluster

Samuel C. Wang, MD, FAAFP and Sumana Basu, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Primary headache disorder

  • Multiple attacks of unilateral, excruciating, sharp, searing, or piercing pain; typically localized in the periorbital area and temple accompanied by signs o...

DIAGNOSIS

  • Diagnosis is clinical.

  • International Classification of Headache Disorders (3rd edition) criteria

  • At least five attacks of severe or very severe unilateral orbital, supraorbital, and/or tempora...

TREATMENT

Many of the medications discussed in the following section are used off-label in the treatment of CH. 

GENERAL MEASURES

  • Avoid major changes in sleep habits.

  • Stop smoking.

  • Avoid use of alcohol du...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Anticipate cluster bouts and initiate early prophylaxis.

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

  • Watch for adv...

REFERENCES

1
Robbins M, Starling A, Pringsheim T, et al. Treatment of cluster headache: the American Headache Society evidence-based guidelines. Headache.  2016;56(7):1093–1106. [View Abstract on ...

ADDITIONAL READING

  • Gaul C, Diener HC, Silver N, et al. Non-invasive vagus nerve stimulation for PREVention and Acute treatment of chronic cluster headache (PREVA): a randomised controlled study. Cepha...

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

  • CHs are uncommon but very disabling.

  • Patients are often agitated and restless during the acute attack.

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

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