Diagnosing Cluster Headaches

Cluster headaches are the most frequent type of headaches belonging to the group known as the trigeminal-autonomic cephalalgias. These are primary, unilateral headaches that occur with cranial autonomic symptoms. Cluster headaches occur predominantly around the eye and the temporal region but may radiate to the jaws and teeth. The pain usually occurs around the same time each day and often will wake the patient from sleep. Triggers of acute cluster attacks include alcohol, elevated environmental temperature, exercise and nitroglycerine medications. The diagnosis is made after a careful history and examination are obtained and other structural causes are excluded. The typical cluster headache is associated with cranial autonomic features, which almost always occur unilaterally on the same side as the pain. Cluster headache always occurs on one side of the face, usually in and around the eye. Patients usually describe the pain as hot, searing, pricking or drilling, rather than dull or aching.