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