A3.1 Cluster headache (alternative criteria)

Diagnostic criteria:
  1. At least five attacks fulfilling criteria B-D
  2. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated)1
  3. Either or both of the following:
    1. at least one of the following symptoms or signs, ipsilateral to the headache:
      • – conjunctival injection and/or lacrimation
      • – nasal congestion and/or rhinorrhoea
      • – eyelid oedema
      • – forehead and facial sweating
      • – forehead and facial flushing
      • – sensation of fullness in the ear
      • – miosis and/or ptosis
    2. a sense of restlessness or agitation
  4. Occurring with a frequency between one every other day and 8 per day2
  5. Not better accounted for by another ICHD-3 diagnosis.
Notes:
  1. During part, but less than half, of the active time-course of A3.1 Cluster headache, attacks may be less severe and/or of shorter or longer duration.
  2. During part, but less than half, of the active time-course of A3.1 Cluster headache, attacks may be less frequent.
Comment:

Opinion is divided on inclusion of (e) and (f) in criterion C1. Experts in the working group believe it improves sensitivity without significant loss of specificity, but formal field testing has not confirmed this.