Cluster Headache Syndrome Differential Diagnosis Table

Cluster Headache Syndrome Differential Diagnosis Table:

Cluster headache is a very rare type of primary headache that causes severe unilateral pain that occurs in clusters or periods lasting for weeks, and each period is for around 2 hours. The pain affects the temple, peri, and retroorbital regions and is so excruciating and intense that these headaches are referred to as “suicide headaches” in the literature. People who have had them describe them as difficult to tolerate and as being so severe that it is somewhat similar to labor pain during childbirth.
Cluster headaches are among the trigeminal autonomic cephalgia, a group of headache conditions along the divisions of the trigeminal nerve. The typical symptoms include intense, sharp, and burning unilateral pain. In addition to this, they are frequently accompanied by autonomic symptoms, namely lacrimation, aural fullness, nasal congestion, facial flushing, facial swelling, throat irritation, small pupils, eyelid drooping, eye redness, and irritation.

How To Distinguish Cluster Headache Syndrome from Other Diseases

Distinguish Tension-Type Headache from Cluster Headache Syndrome – Diagnosis

Tension-type headache is a common headache condition that causes mild to moderate pain affecting both sides of the head, back of the head, and neck.

• Tension-type headache is always bilateral, while a cluster headache is strictly unilateral.
• Tension-type headaches cause mild to moderate level pain and discomfort. On the other hand, cluster headaches are known to be causing severe headache that is difficult to tolerate.
• Furthermore, rarely found in tension-type headache, eye tearing, lacrimation, aural fullness, nasal congestion, pale skin, and drooping of eyelids occur frequently with cluster headaches.

Distinguish Migraine from Cluster Headache Syndrome – Diagnosis

Migraine is another common headache condition that causes throbbing pain and associated symptoms affecting one side of the head.

• Migraine attacks usually last longer, taking up to 72 hours. Cluster headache attacks are brief, ranging from 2-3 hours.
• Migraine is almost always associated with aura, nausea, and vomiting. On the other hand, these are rarely to be found along cluster headaches.
• There is a dearth of evidence that links cluster headaches to visual disturbances like vision blurring, flashes of light, and photophobia. A very common manifestation of migraines.

Distinguish Tumor Headache from Cluster Headache Syndrome – Diagnosis

Tumors do not cause headaches themselves; they can only arise when the tumor presses a nearby vessel or nerve. They are not typically restricted to a specific region, they can be present anywhere, and cause pressing and dull pain in that area.

• Tumor headaches are commonly accompanied by one or two other neurological symptoms, like slurred speech, seizures, weakness, dizziness, and paralysis. These are unusual with cluster headaches.
• Cluster headaches usually respond to pain medication. However, taking pain medication does not relieve the headache caused by a tumor.
• The nature of pain associated with cluster headaches is severe in nature. While the tumor usually causes a headache more dull and pressure-like in nature.

Distinguish Trigeminal Neuralgia from Cluster Headache Syndrome – Diagnosis

Trigeminal neuralgia is a neurological condition that causes sudden ipsilateral electric shock-like pain along the divisions of the trigeminal nerve, usually triggered by touching the face, shaving, brushing, and eating.

• Both of them differ by the duration of the pain. Trigeminal neuralgia attack lasts for seconds, meanwhile, a cluster headache lasts for 2 to 3 hours.
• Trigeminal neuralgia pain occurs along the divisions of the trigeminal nerve. It can be present around the maxilla and the mandibular region. On the other hand, the cluster headache is present around the orbital and the temple region only.

“During clinical examination, in fear of triggering the trigeminal neuralgia attack, patients are very apprehensive about letting anyone touch their face.“

Distinguish Migraine Variants from Cluster Headache Syndrome – Diagnosis

The migraine variants are frequently misdiagnosed, as they manifest themselves very similarly to the other headache types. They are quite similar to migraines except for the symptom headache.

• Migraine variants are usually accompanied by aura; alternatively, cluster headaches never present with aura.
• An important distinguishing factor is a headache. Migraine variants never cause headaches, while cluster headaches are known to be causing extreme headaches.

Distinguish Sinusitis from Cluster Headache Syndrome – Diagnosis

Sinusitis is an inflammation of the mucosal membrane of the paranasal sinuses. Both of them present with symptoms similar to each other, like nasal congestion and lacrimation. But there are some differences that separate them:

• The nature of sinusitis headache pain feels like pressure and dull pain. While cluster headaches produce sharp, severe, and intense pain.
• Sinusitis headache is often accompanied by facial pain and swelling. Cluster headache pain is confined to the temple and orbital region only.
• Sinus headaches are bilateral, unlike cluster headaches that are unilateral.

“Upon clinical examination, it can be observed that cluster headache patients might have drooping eyelids and pale skin. Moreover, sinusitis patients give a history of exacerbation of pain with positional changes like bending the head down. Also, the facial skin is tender upon palpation.”

Distinguish Cavernous Sinus Syndrome from Cluster Headache Syndrome – Diagnosis

Cavernous sinus syndrome arises as a result of any disease process affecting the cavernous venous sinus, producing symptoms like conjunctival edema, protrusion of the eyeball, ophthalmoplegia, autonomic dysfunction, and sensory loss.

• It can be appreciated that both conditions affect the eye and produce sharp, intense pain around it. However, cavernous sinus syndrome causes eye swelling by the protrusion of the eyeball. Cluster headaches may cause eyelid swelling but never the eyeball.
• Furthermore, cavernous sinus syndrome causes the affected eye muscles to paralyze, making it difficult for the patient to close it. Whereas, it won’t present with cluster headache symptoms.

Distinguish Tolosa-Hunt Syndrome from Cluster Headache Syndrome – Diagnosis

Tolosa-Hunt syndrome is reported as an inflammation of the cavernous venous sinus, orbital space, and superior orbital fissure causing limited eye movements and pain around the eye.

• This syndrome frequently results in restricted eye movement, which never occurs in cluster headaches.
• Moreover, these patients face visual disturbances along with diplopia, a very rare finding in cluster headaches.
• Other than these, unlike cluster headaches, facial numbness can be found in Tolosa-Hunt syndrome.

Distinguish Paroxysmal Hemicrania from Cluster Headache Syndrome – Diagnosis

Paroxysmal Hemicrania is a rare form of headache that affects one side of the head and is characterized by repeated severe pain attacks occurring around four to five times every day.

• Cluster headaches and paroxysmal hemicrania both belong to trigeminal autonomic cephalgia. However, they can be differentiated upon the duration of pain. Paroxysmal hemicrania pain is short-lasting, usually staying up to 5 to 30 minutes, whereas cluster headache attacks range between 2 to 3 hours.

“The differential diagnosis is established in the literature through the use of the drug indomethacin. It relieves paroxysmal hemicrania pain but not cluster headache.”

Important Red Flags in Cluster Headache Syndrome

The most common types of headaches are cluster headaches, tension-type headaches, and migraine headaches, which are primary types of headaches. It means that the headache itself is the problem and is not produced as a result of an underlying condition. On the other hand, secondary headaches are produced as a result of an underlying condition and they need to be further investigated as they can be life-threatening.
Cluster headaches do not result in fever, paralysis, weakness, slurred speech, double vision, pain increase due to positional changes, coughing, or sneezing. These are all signs indicating an underlying issue, like a tumor, inflammation, and infection. They need further attention.