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Headache, Cluster

Headache, Cluster is a topic covered in the 5-Minute Emergency Consult.

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  • Excruciatingly painful primary headache disorder
    • Infrequent cause of ED visits and affects only 0.1% of the population
  • Often has abated by time of presentation
    • Attacks last between 15 and 180 min (75% last <60 min)
  • More common in men (∼3:1)
  • Onset usually between 30 and 50 yr of age
  • Headaches occur in clusters lasting weeks to months followed by remission >1 mo
  • Commonly occur 1–3 times per day during cluster period that lasts 2–3 mo
  • Often occur during the same time of day
  • Often occur during the same time of the year
    • Highest incidence in spring and fall
  • Chronic cluster headache:
    • Remission <1 mo
    • Do not experience remission
    • 10% of patients
  • May have many clinical and pathophysiologic similarities with migraine and variants
  • Often follows a trigeminal nerve dermatome


A well-described physiologic reflex arc, the trigeminovascular reflex, potentiates the trigeminal pain and cranial autonomic features of cluster headache by positive feedback mechanisms.

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Rosen, Peter, et al., editors. "Headache, Cluster." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster.
Headache, Cluster. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster. Accessed April 25, 2019.
Headache, Cluster. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster
Headache, Cluster [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Headache, Cluster ID - 307059 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -