Contents
Cluster headache or suicide headache is an excruciating, strictly one-sided pain syndrome with attacks that last between 15-180 minutes and that are accompanied by marked ipsilateral cranial autonomic symptoms, such as lacrimation and conjunctival injection.
- M/C type of trigeminal autonomic cephalgia (TACs)
Classification
ational Headache Society (IHS) classification of primary headaches:
- Migraine
- Tension headache
- Trigeminal autonomic cephalalgias (of which cluster headache is the most prominent variety)
- Group 4 “other primary headache disorders”: Consists of 10 rare headache syndromes with well-established primary nature
- Benign exertional headaches
- Primary stabbing headaches (“jabs and jolts syndrome”)

Trigeminal autonomic cephalgias (TACs):
- Cluster headache (M/C)
- Paroxysmal hemicrania (PH)
- Hemicrania continua (HC)
- Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)

Pathophysiology
Trigeminal-autonomic reflex with parasympathetic activation (hallmark feature):
- Trigeminal-autonomic reflex: Consists of a brainstem connection between the trigeminal nerve and facial cranial nerve parasympathetic outflow

Presentation
Headache:
Short lasting attacks of unilateral severe headache with severe ipsilateral cranial autonomic symptoms.
- Unilateral severe episodic headaches
- Restlessness during attacks
- Ipsilateral autonomic symptoms
- Location: Periorbital
- Duration: < 3 hours (short-duration)
- 8-10 weeks of symptoms followed by symptom-free interval
- Stabbing/boring quality
- Nocturnal pain, precipitated by alcohol
- Associated features:
- Photophobia
Ipsilateral cranial autonomic symptoms:
- Conjunctival injection and/or lacrimation
- Nasal congestion and/or rhinorrhea
- Eyelid oedema
- Forehead & facial sweating
- Aural fullness
- Ptosis/miosis

Diagnosis
International Classification of Headache Disorders-3 beta (2013) diagnostic criteria for cluster headache:

Management
Oxygen therapy:
- 100% oxygen in 10l/min for 10-15 min
- Sumatriptan 6mg SC
Prophylaxis:
- Short-term prevention: Steroids
- Long-term prevention: Verapamil > Lithium
Summary:
