Cluster Headache: Clinical Presentation, Lifestyle Features, and Medical Treatment


  • Markus Schürks MD,

  • Tobias Kurth MD,

  • Janete De Jesus MD,

  • Mira Jonjic MD,

  • Dieter Rosskopf MD,

  • Hans-Christoph Diener MD

  • From the Department of Neurology, University of Duisburg-Essen, Essen, Germany (Dr. Schürks, de Jesus, Jonjic, and Dr. Diener); Divisions of Preventive Medicine and Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston, MA (Dr. Kurth); and Institute of Pharmacology, Peter Holtz Research Center of Pharmacology and Experimental Therapeutics, University Hospital, Ernst-Moritz Arndt University, Greifswald, Germany (Dr. Rosskopf).

Address all correspondence to Dr. Markus Schürks, Department of Neurology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.


Background.—Cluster headache (CH) is a rare but severe headache form with a distinct clinical presentation. Misdiagnoses and mismanagement among these patients are high.

Objective.—To characterize clinical features and medical treatment in patients with CH.

Methods.—We established a cohort of 246 clinic-based and non-clinic-based CH patients. The diagnosis of CH was verified according to International Headache Society (IHS) criteria. We used standardized questionnaires to assess associated factors as well as success or failure of treatments.

Results.—The majority (75.6%) was not treated before at our clinic—77.6% were males; 74.8% had episodic CH, 16.7% had chronic CH, in the remaining patients, the periodicity was undetermined because they were newly diagnosed. Cranial autonomic features were present in 98.8%, nausea and vomiting in 27.8%, and photophobia or phonophobia in 61.2% of CH patients. Most (67.9%) reported restlessness during attacks and 23% a typical migrainous aura preceding the attacks. The rate of current smoking was high (65.9%). Half of the patients reported that alcohol (red wine in 70%) triggered CH attacks. Eighty-seven percent reported the use of drugs of first choice (triptans 77.6%, oxygen 71.1%) with sumatriptan subcutaneous injection being the most effective drug for acute therapy (81.2%). The most frequently used preventive medications were verapamil (70.3%) and glucocorticoids (57.7%) with equally high effectiveness.

Conclusions.—Apart from the IHS criteria additional features like nausea/vomiting and migrainous aura may guide the diagnosis of CH. A large number of CH patients do not receive adequate treatments.