Investigations
1st investigations to order
brain and pituitary MRI without and with intravenous contrast
erythrocyte sedimentation rate
Test
Used to exclude giant cell arteritis in patients over 50 years of age.
Result
normal in primary cluster headache
Investigations to consider
pituitary function tests
Test
Blood tests, including thyroid function tests, luteinising hormone, follicle-stimulating hormone, insulin-like growth factor 1, cortisol, prolactin, testosterone, estradiol, progesterone, glucose, and growth hormone, should be considered at the discretion of specialist.
Result
normal in primary cluster headache; abnormalities may suggest secondary causes resulting from a pituitary adenoma
magnetic resonance angiography (MRA) head and neck with and without contrast
Test
Should be considered In the presence of a partial Horner syndrome or medically refractory cases.
Result
normal in primary cluster headache; abnormal results might indicate secondary causes
brain CT scan
Test
Less sensitive than MRI, so should be considered only if MRI is contraindicated.[21]
Result
normal in primary cluster headache; may reveal suprasellar extent of a pituitary mass
polysomnogram
Test
Useful for patients with a history that suggests sleep apnoea (which has been suggested as being over-represented in patients with cluster headache) and for patients with medically intractable chronic cluster headache.[22]
Result
abnormal in patients with sleep apnoea
ECG
Test
Used to exclude conduction abnormalities before starting treatment with calcium-channel blocker (i.e., verapamil) or increasing verapamil dose.[25]
Result
often normal; conduction abnormalities or evidence of ischaemic changes may alter drug choices
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