Cluster Headache: Or something else? Differential Diagnosis

Eyes and eye appendages (H00-H59).

  • Glaucoma attack – eye disease with seizure-like elevation of intraocular pressure.

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)
  • Aneurysms (spindle- or sac-shaped vasodilatation of an artery)
  • Arteriovenous malformations (AVM) – congenital malformation of blood vessels in which the arteries are directly connected to the veins; these occur mainly in the CNS and facial cranium.

Neoplasms – tumor diseases (C00-D48).

  • Brain tumors, unspecified
  • Tumorous processes in the cavernous sinus (a venous blood duct of the brain belonging to the sinus durae matris)
  • Pituitary adenoma (sella; benign tumor of the pituitary gland).
  • Nasal cavity tumors
  • Paranasal sinus tumors

Psyche – nervous system (F00-F99; G00-G99)

  • Chronic paroxysmal hemicrania – headache that does not have symptom-free intervals; these should be differentiated by differential diagnosis because of good responsiveness to indomethacin
  • Chronic hemiparesis headache
  • Encephalitis (inflammation of the brain)
  • Idiopathic stabbing facial pain (1st trigeminal branch); pain character: neuralgiform; intensity: moderate to severe attack duration: seconds to a few minutes; attack frequency: 1/year to 100/day; good response to indomethacin
  • Hemicrania continua – headache persisting unilaterally radiating; attack frequency: 5-12/day; good response to indomethacin
  • Tension-type headache
  • Meningitis (meningitis)
  • Migraine – migraine attacks, however, usually last longer than 4 hours and do not occur several times a day!
  • Paroxysmal hemicrania – chronic headache (orbital, temporal) characterized by strictly unilateral attacks of pain; age: 20-40 years; pain character: stabbing; intensity: very high; attacks duration 2-45 minutes; attacks frequency: 1-14/day; good response to indomethacin.
  • Primary sleep-related headache (as frontal, median); age: 40-70 years; pain character: drilling, pressing and; intensity: moderate; attacks duration 30-120 minutes; attack frequency: 1-2/day
  • SUNCT syndrome (shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea). – Headache (orbital, temporal) with shorter attacks and higher frequency than cluster headache; sex ratio: males to females is 17: 1;age: 20-50 years; pain character: stabbing; pain intensity: moderate to high; attack duration: 5-250 seconds; attack frequency: 1/day to 30/day; good response to indomethacin
  • Trigeminal neuralgia – usually unexplained severe pain in the face due to irritation of a facial nerve.
  • Cervicogenic headache – headache associated with changes in the cervical spine (CS).

Injuries, poisoning and other sequelae of external causes (S00-T98).

  • Traumatic corneal lesions – injuries to the cornea, due to an accident or surgery.