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
sinusite

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: SUNCT Paroxysmal hemicrania Cluster headache Trigeminal neuralgia
Sex-ratio W > H W>H 1 W/4 M W > H
Duration of attacks < 3 minutes 2 to 30 minutes 15 to 180 minutes 2–3 s to some minutes
Frequency of attacks 5 to 80 per day 2 to 40 per day 1 to 8 per day 5 to > 100 per day
Pain Laterality Strictly unilateral Strictly unilateral Strictly unilateral Mostly unilateral
Pain distribution Ocular Orbitotemporal Orbitotemporal V2/V3 > V1
Type of pain Stabbing Pulsatil with photophobia and phonophobia Crushing, tearing, ice pick Electric shock, burn
Pain intensity Severe Severe to very severe Very severe Very severe
Dysautonomic signs Presents Presents Presents Occasional eye congestion
Impact of attacks on activity Activity possible but difficult Normal activity not possible Normal activity not possible, agitation Brief sideration during the shock
Attack triggers Chewing, cold wind on the face, speaking, touching the face, bright light. Irritation, excitement, sudden change of position, hormonal change. Nothing, sleep, alcohol intake Trigger areas: Talking, chewing

“Classic” additional examinations

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

Electroencephalography

Diagnostic différentiel : Potentiels évoqués

Evoked potentials