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Headache, Cluster, Emergency Medicine

Andrew K. Chang Reviewed 06/2017



  • Excruciatingly painful primary headache disorder

    • Infrequent cause of ED visits and affects only 0.1% of the population

  • Often has abated by time of presentation

    • Attacks last between 15 a...


Signs and Symptoms


  • Unilateral pain (usually does not change sides between headaches)

  • Sharp, stabbing, boring

  • Acute onset and builds in intensity quickly with climax at 5–15 min

  • Pain stops...



  • Recognize more severe life-threatening causes of headache

  • Administration of oxygen by face mask may alleviate symptoms

Initial Stabilization/Therapy

  • Rule out life-threatening causes...



Admission Criteria

  • Persistent headache unresponsive to usual measures

  • Unclear headache diagnosis

Discharge Criteria

  • Patients with moderate to complete pain relief, a normal neurologic...

Pearls and Pitfalls

  • History is essential to diagnose cluster headache as pain may be improved upon presentation

  • 100% oxygen should be the 1st treatment initiated

  • Cluster headaches may be so severe that ...

Additional Reading

  • Cohen  AS, Burns  B, Goadsby PJ. High-flow oxygen for treatment of cluster headache: A randomizedtrial. JAMA.  2009;302:2451–2457.

  • Friedman  BW, Grosberg  BM. Diagnosis and mana...



  • 339.00 Cluster headache syndrome, unspecified

  • 339.01 Episodic cluster headache

  • 339.02 Chronic cluster headache


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

  • G44.019 Episod...

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