Pain localization in cluster headache patients: Onset, peak, and radiation

Acta Neurol Scand. 2021 Apr;143(4):441-449. doi: 10.1111/ane.13396. Epub 2021 Feb 1.


Objective and aim: To describe differences in pain locations for onset, peak, and radiation aspects of cluster headache (CH) attacks.

Methods and materials: Data were collected for 23 months using a cross-sectional online survey composed of 117 questions on pain location, demographics, and clinical features. 5260 datapoints on 44 pain locations from 631 respondents were analyzed.

Results: During the onset and peak of attacks, pain is concentrated periorbitally. Pain locations outside the periorbital region were reported more frequently for radiation than for onset and peak of attacks. Dorsal (occipital, neck, shoulder) pain was reported more frequently in connection with onset and radiation than during peak: onset (13%) versus peak (6%), p < 0.001, and radiation (22%) versus peak (6%), p < 0.001. There was no significant difference in dorsal pain frequencies for onset (13%) vs. radiation (22%), p = 0.552. Furthermore, the frequency with which individual pain locations were reported differed significantly for onset, peak, and radiation in CH.

Conclusions: Analysis of the pain location data shows specific frequencies and distributions of pain location for three aspects of CH attacks. The frequency with which individual pain points were reported differed significantly for onset, peak, and radiation. In general, dorsal pain points were reported more frequently for onset and radiation than for peak pain. Pain locations beyond the eye (extraorbital points) were more frequently reported in connection with radiating pain. Our findings could serve as a basis for future research, correlating CH pain patterns with the outcome of treatment approaches.

Keywords: cluster headache; pain; pain location.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cluster Headache / diagnosis*
  • Cluster Headache / psychology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / diagnosis*
  • Pain / psychology*
  • Pain Measurement / methods*
  • Pain Measurement / psychology*
  • Young Adult