Tests

1st tests to order

brain and pituitary MRI without and with intravenous contrast

Test
Result
Test

Recommended at time of diagnosis to eliminate secondary causes.[21]​​[22]

Result

normal in primary cluster headache; abnormal results might indicate secondary causes (e.g., tumor, cavernous sinus pathology)

erythrocyte sedimentation rate

Test
Result
Test

Used to exclude giant cell arteritis in patients over 50 years of age.

Result

normal in primary cluster headache

Investigations to avoid

Electroencephalography (EEG)

Recommendations
Rationale
Recommendations

Do not routinely request EEG in patients with cluster headache.[25]

Rationale

EEG has no advantage over clinical evaluation in diagnosing headache and does not improve outcomes.[25]

There is no consistent evidence to demonstrate that EEG improves diagnostic accuracy. EEG has not been shown to identify headache subtypes or screen for structural causes of headache.[27]

Tests to consider

pituitary function tests

Test
Result
Test

Blood tests, including thyroid function tests, luteinizing 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
Result
Test

Should be considered in the presence of a partial Horner syndrome or medically refractory cases.[22]

Result

normal in primary cluster headache; abnormal results might indicate secondary causes

brain CT scan

Test
Result
Test

Less sensitive than MRI, so should be considered only if MRI is contraindicated.​

Result

normal in primary cluster headache; may reveal suprasellar extent of a pituitary mass

polysomnogram

Test
Result
Test

Useful for patients with a history that suggests sleep apnea (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 apnea

ECG

Test
Result
Test

Used to exclude conduction abnormalities before starting treatment with calcium-channel blocker (i.e., verapamil) or increasing verapamil dose.[24]

Result

often normal; conduction abnormalities or evidence of ischemic changes may alter drug choices

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