Cluster headache

IBAN: BE74 0682 5035 5007

OUCH Belgium
OUCH Belgium NPO- Patients association

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Diagnostic différentiel : IRM

Differential diagnosis

A diagnosis is generally made after examination with a specialist, as cluster headache has specific characteristics.

However, it will only be confirmed after further clinical examinations to exclude any other form of primary or secondary headache.

Why a differential diagnosis?

It is important not to confuse cluster headache with other types of headache.
Indeed, confusion is very common among patients and the disease is unfortunately not well known in the medical sector.

In addition, a neurologist specialised in headaches should exclude any other pathology that may induce a secondary headache. In fact, these should absolutely be detected as their consequences are often more serious:

  • Thunderclap headache
  • Meningitis
  • Subdural hematoma
  • Stroke
  • Carotid dissection
  • Temporal arteritis
  • Result of head injury
  • Medication-related
  • etc.
Differential diagnosis makes it possible to differentiate a certain disease from others which present similar symptoms.
Additional examinations confirm the final diagnosis

Frequent diagnostic errors

From the patient (self-diagnosis):

  • Sinusitis
  • Ocular Conditions
  • Toothache
  • Migraine

Sinusitis is generally frontal or maxillary. The associated pains are located “around” the eye.

Problème dentaire

Unnecessary teeth extractions are unfortunately too frequent.

Frequent diagnostic errors

From the medical side (non-headache specialists):

  • Migraine
  • Tension headache
  • Trigeminal neuralgia
  • Paroxysmal hemicrania
migraine - céphalée de tension

Tension headache.

Trigeminal neuralgia.

Difficulties in differential diagnosis

Similar to cluster headache:

  • Trigeminal neuralgia
  • Chronic paroxysmal hemicrania
  • SUNCT syndrome

In order to allow distinctions, the following table shows you possible “overlaps”.

Hence the importance of asking precise questions to the patient.

IHS Infos on:SUNCTParoxysmal hemicraniaCluster headacheTrigeminal neuralgia
Sex-ratioW > HW>H1 W/4 MW > H
Duration of attacks< 3 minutes2 to 30 minutes15 to 180 minutes2–3 s to some minutes
Frequency of attacks5 to 80 per day2 to 40 per day1 to 8 per day5 to > 100 per day
Pain LateralityStrictly unilateralStrictly unilateralStrictly unilateralMostly unilateral
Pain distributionOcularOrbitotemporalOrbitotemporalV2/V3 > V1
Type of painStabbingPulsatil with photophobia and phonophobiaCrushing, tearing, ice pickElectric shock, burn
Pain intensitySevereSevere to very severeVery severeVery severe
Dysautonomic signsPresentsPresentsPresentsOccasional eye congestion
Impact of attacks on activityActivity possible but difficultNormal activity not possibleNormal activity not possible, agitationBrief sideration during the shock
Attack triggersChewing, cold wind on the face, speaking, touching the face, bright light.Irritation, excitement, sudden change of position, hormonal change.Nothing, sleep, alcohol intakeTrigger areas: Talking, chewing

“Classic” additional examinations

  • EEG -Electroencephalography
  • MRI
  • Evoked potentials
Diagnostic différentiel : Électroencéphalogramme


Diagnostic différentiel : Potentiels évoqués

Evoked potentials