Duration Can Differentiate Cluster Headaches from the Rest

TAC includes hemicrania continua, paroxysmal hemicrania, and SUNCT/SUNA, and cluster headache. Cluster HA is relatively commonTACs, which affect around 1% of the population and, unlike migraines, have a male to female ratio of about 2:4. Cluster headaches can occur at any age, but may peak in one’s 20s or 50s.

Cluster headaches can be intense and dramatic for the patient, and they require unique treatment, he explained. Compared to migraines, which may last several hours to a full day, are unilateral (but can switch sides), and have no autonomic symptoms, cluster headaches include:

  • a “locked side”
  • a short duration (15 minutes to 3 hours, typically)
  • autonomic symptoms (eg, congestion, eyelid oedema, facial sweating)
  • agitation and restlessness (patients may be rocking/pacing).

MAN HOLDING HIS HEAD SUFFERING FROM Trigeminal Autonomic Cephalgia


Acute treatments for clusters using sumatriptan, zolmitriptan, and oxygen are most common while prophylactic therapy may involve suboccipital steroid injection, verapamil, lithium, melatonin, warfarin, or prednisone.

Paroxysmal hemicranias and hemicranias continua (headaches that may last several months (with fluctuation) differ from cluster headaches in their response to indomethacin, a nonsteroidal anti-inflammatory drug (NSAID). When other diagnostics are similar to cluster headache syndrome except for a patient’s reaction to indomethacin, that – along with duration/frequency of the pain – may help confirm the diagnosis. Topiramate and gabapentin may also work for hemicranias continua, in particular, if the patient cannot tolerate NSAIDs.

Indomethacin is worth a trial in patients with side-locked headaches,