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Cluster headache How we diagnose and what can we improve?
Dr Alina Buture Research Fellow in Neurology
Cluster headache
• Uncommon condition
• Prevalence 1/1000
• The worst pain known to man
• Female patients who suffer from cluster
headache describe the pain
as ‘worse than childbirth’
http://pregnancyhumor.com
Excruciating headaches
How to recognise cluster headache?
http://khannea-suntzu.zerostate.net
How to recognise cluster headache?
Strictly unilateral/frontal/around eyeball
Cluster Headache by JD Fletcher
How to recognise cluster headache?
Runny nose/blood shot/droopy eye
http://www.ati-spg.com
How to recognise cluster headache?
Duration: 15-120 min
https://www.fotolia.com
How to recognise cluster headache?
Early morning attacks
https://www.pexels.com
How to recognise cluster headache?
https://thesaurus.plus
Restlessness
How to recognise cluster headache?
More common in men
https://vectortoons.com
How to recognise cluster headache?
More common in smokers
https://es.pngtree.com/freepng
How to recognise cluster headache?
Triggered by alcohol
http://blogaboutbeer.com
Episodic vs chronic cluster headache
Episodic
Chronic
Misdiagnosis and delays in diagnosis
Not everyone fits in the box
https://imgflip.com
Misdiagnosis and delays in diagnosis
No specific tests available
https://www.keepcalm-o-matic.co.uk
Misdiagnosis and delays in diagnosis
Misdiagnosis in ED and primary care
http://www.reframehealthfilms.com
Misdiagnosis and delays in diagnosis
Trigeminal neuralgia
http://www.cohenkayedental.com
Misdiagnosis and delays in diagnosis
Sinusitis
http://www.cohenkayedental.com
Neuropeptides in cluster headache
CGRP PACAP VIP NPY
Normal MRI head
Functional MRI in cluster headache
Morelli et al. J Headache Pain (2009) 10:11–14
How can we improve the diagnosis of cluster headache?
• Educational activities for doctors (GPs, ED, ENT doctors)
• Blood tests, brain scans – research
• Screening tools
Screening tool for cluster headache
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