As a rule, patients with cluster headaches can describe the occurrence of their attacks in great detail. Determining the duration of the cluster headache attack is sometimes problematic. When two, three, or four cluster headache attacks occur, patients are unsure whether it is a single attack lasting eight hours intermittently or whether it is multiple attacks. In such cases, keeping a headache calendar can provide more information. As long as the patients have not received medical treatment, they will usually have taken a variety of painkillers. Since the cluster headache attack usually subsides after an hour, patients have the impression that the improvement is due to the medication. It is only because of the long duration of cluster periods and due to the accompanying neurological disorders that patients then seek help. In order to make a diagnosis, the characteristics of the headache attack must be inquired about in detail. These primarily include the duration, the one-sidedness, the severity of the attack, the typical accompanying symptoms, the location in the eye area and also the patient's behavior during the attack.

Since patients often do not notice the accompanying neurological disorders themselves, it is recommended to ask the patient to look in the mirror during the attack.

A particularly simple but precise way to document the symptoms of the headache and show it to the treating doctor is to have a relative film the headache attack with a video camera or have it photographed with a camera. It is particularly important to record the changes in the affected eye.

A regular neurological and general examination is required to make the diagnosis. Additional medical findings, such as computer tomograms or magnetic resonance tomograms, cannot currently make any specific contribution to the diagnosis. However, there are situations in which there is doubt as to whether it is a primary headache disorder. Such doubts arise in particular when the following conditions exist:

  • Cluster headache occurs for the first time in a very young patient (under the age of 20) or in patients over the age of 60.
  • There is a particular need for a detailed neurological examination with additional imaging procedures if the headache takes a gradually increasing course or if additional uncharacteristic accompanying disorders occur, in particular concentration disorders, memory disorders, nausea, vomiting, impaired consciousness, epileptic seizures, etc.

In the case of the above-mentioned conditions, the imaging procedure that is primarily carried out is a magnetic resonance tomogram of the brain and a computer tomogram of the bony skull base. Particular attention should be paid to a possible pituitary tumor or a mass in the area of ​​the skull base (e.g. metastasis). Nasal and paranasal sinus processes must also be recorded.


A characteristic course of cluster headaches cannot be specified in individual cases. Long-term epidemiological studies are not available. Active cluster headache production after the age of 75 is almost never observed. Transitions from an episodic to a chronic cluster headache can be observed, as well as vice versa. The influence of prophylactic medication on the spontaneous course is still unknown.

80% of patients with primary episodic cluster headache still suffer from episodic cluster headache after 10 years, while 12% develop chronic cluster headache after a primarily episodic course.

In over half of those affected by primary chronic cluster headache, this chronic form persists even after 10 years without any long-term remission phases. A longer-lasting remission phase of more than three years can only be expected in around 10%.