How is the pain of cluster headache (CH) characterized?

Updated: Jun 07, 2019
  • Author: Michelle Blanda, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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The pain of CH is manifested as follows:

  • Character - Excruciating, stabbing, sharp, and lancinating (as if the eye is being pushed out), rather than throbbing

  • Location – Unilateral, in the periorbital, retro-orbital, or temporal regions, though pain sometimes radiates to the cheek, jaw, occipital, and nuchal regions; the pain tends to remain on the same side during the cluster period but in rare cases may switch sides

  • Distribution - First and second divisions of the trigeminal nerve; approximately 18-20% of patients complain of pain in the extratrigeminal areas (eg, the back of the neck, along the carotid artery)

  • Onset – Sudden, peaking in 10-15 minutes

  • Duration - 5 minutes to 3 hours per episode

  • Frequency - May occur 1-8 times a day for as long as 4 months (often nocturnal)

  • Periodicity - Circadian regularity in 47%

  • Remission - Long symptom-free intervals occur in some patients; the length of these remissions averages 2 years but may range from 2 months to 20 years

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