Cluster headache (CH) is a severe primary headache disorder with three distinct clinical features: Extremely severe short-lasting headaches occurring in the first division of the trigeminal nerve; ipsilateral cranial autonomic symptoms; striking rhythmicity of attack occurrence. Despite great advances in our understanding of CH, the pathophysiology remains largely unresolved. Studying the clinical characteristics can offer more insight to the athophysiology, but most studies on the subject derives from cross-sectional interview-based studies, which have methodological limitations. Using different approaches, the overall aim of this thesis was to add to the current knowledge of the clinical presentation of CH.

In study 1 we investigated the nature and prevalence of pre-ictal symptoms and the order by which they occur. In an interview-based study of 80 episodic (eCH) and chronic (cCH) patients, we found, that most CH patients experience pre-ictal symptoms and that the earliest pre-ictal symptoms indicate hypothalamic involvement in the early phases of the attack.

In the second study we set out to achieve the first complete description of the CH attack from beginning to end. Using a headache diary 57 eCH and cCH patients prospectively recorded the clinical characteristics of up to 10 attacks per patients. We obtained 500 detailed attacks.... 

Supervisor: Professor Rigmor Højland Jensen, Dr.Med.Sci.

Supervisor: Professor Messoud Ashina MD, Dr.Med.Sci.

Supervisor: Mads Christian Johannes Barløse MD, PhD.