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A 30 year old lady reports daily headache around left eye in afternoon since a month. Headache lasts for an hour and may sometimes recur in the night. There is redness and watering in the left eye during pain. She has nausea, photophobia and restlessness during the attack and it subsides abruptly. She had similar bout on right side at the same time two years ago which lasted a month, with milder left sided pain once a month. A trial of Indomethacin was unsuccessful<br><br>Which of these features reliably distinguish cluster from migraine?
Explanation
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Cluster headache though more common in men, the male to female ratio has changed from 8:1 to 3:1. Photophobia, phonophobia, facial allodynia, nausea and prodromal features may also be seen in cluster. Rarely headache may change side during a cluster and patients get interictal pain of varying intensity between clusters called shadow headache. Trigeminal autonomic features are not uncommon in migraine. The most reliable features to differentiate cluster from migraine are short duration (less than 4 hours), higher frequency (more than one attack a day), rapid escalation/cessation within minutes and restlessness during an attack
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Reference
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Burish M. Cluster Headache and Other Trigeminal Autonomic Cephalalgias. Continuum 2018;24(4):1137-1156.
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Option 1
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Is Correct (Option 1):
Cluster headache is unlikely in females
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Option 2
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Is Correct (Option 2):
Photophobia and nausea suggest migraine
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Option 3
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Is Correct (Option 3):
Duration of headache and restlessness favor cluster
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Option 4
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Is Correct (Option 4):
Attacks between cluster periods rule out cluster headache
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