- 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 15–180 min (75% last <60 min)
- More common in men (∼3:1)
- Onset usually between 30–50 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
- 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
- Often evolves from episodic cluster headaches
- 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 and subsequent hypothalamic dysfunction
- Release of CGRP from trigeminal perivascular afferents causes vasodilation/modulation of nociceptive activity of trigeminal neurons leading to severe pain
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Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster. Accessed June 6, 2023.
Headache, Cluster. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307059/all/Headache__Cluster
Headache, Cluster [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 06]. 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 - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, 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 -