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Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

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Related Experiment Video

Updated: Jun 20, 2026

3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
10:39

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Cluster-like headache. A comprehensive reappraisal.

F Mainardi1, M Trucco, F Maggioni

  • 1Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venice, Italy. federico.mainardi@ulss12.ve.it

Cephalalgia : an International Journal of Headache
|September 9, 2009
PubMed
Summary

Cluster-like headaches (CLH) can mimic primary cluster headaches (CH), making accurate diagnosis crucial. Red flags like older age at onset and abnormal exams help differentiate secondary causes, emphasizing the need for neuroimaging.

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Last Updated: Jun 20, 2026

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Area of Science:

  • Neurology
  • Headache Medicine
  • Diagnostic Neurology

Background:

  • Cluster headache (CH) is a primary headache disorder with distinct diagnostic criteria (ICHD-II).
  • Secondary cluster-like headaches (CLH) can present similarly to CH, necessitating exclusion of underlying pathologies.
  • Previous observations of secondary cases mimicking CH prompted a literature review of CLH.

Purpose of the Study:

  • To review and analyze reported cases of cluster-like headaches (CLH).
  • To identify clinical features that suggest a secondary, rather than primary, headache origin.
  • To aid in the differential diagnosis between primary cluster headache and secondary CLH.

Main Methods:

  • Conducted an extended literature review of cluster-like headache (CLH) reports from 1975 to 2008.
  • Identified 156 CLH cases, excluding 80 due to inadequate information, leaving 76 for analysis.
  • Categorized the remaining 76 cases into 'fulfilling' (F) and 'not fulfilling' (NF) ICHD-II criteria for CH.

Main Results:

  • Vascular pathologies were the most frequent cause of CLH (38.5%), followed by tumors (25.7%) and infections (13.5%).
  • Older age at onset was a red flag for both fulfilling and not fulfilling groups.
  • For the 'not fulfilling' group, abnormal neurological/general examination (73.6%), attack duration, frequency, and localization were significant red flags.

Conclusions:

  • Approximately 50% of CLH cases initially present as 'fulfilling' cases, perfectly mimicking primary CH.
  • Clinical features such as older age at onset, abnormal neurological findings, and atypical attack characteristics should raise suspicion for secondary CLH.
  • Accurate clinical evaluation and neuroimaging are essential for differentiating CLH from primary CH and identifying underlying causes.