Exams and Tests

• Your doctor must rule out a variety of other causes of facial pain besides cluster headache, including the following unusual forms of headache and facial pain.
  
  
  • Atypical neuralgia
    
    
  • Myofascial pain
    
    
  • Temporomandibular joint pain
    
    
  • Trigeminal neuralgia
    
    
  • Local disease in the sinuses, jaw, throat, and bones of your head
  
  
• Your first experience of a severe explosive headache may be a warning of subarachnoid hemorrhage or bleeding in your head or brain. This is a neurological emergency that doctors are at the ready to treat.
  
  
• A severe headache also can be a warning of a brain tumor or infection in your head. Both these conditions are rare, but because they are life threatening, your doctor will want to rule these out first.
  
  
• Physical examination of your head will help define other possible causes of this painful syndrome. Physical findings in people with cluster headache between attacks are usually normal. During headache attacks, these symptoms may occur:
  
  
  • Eye tearing
    
    
  • Pupil of the eye narrows
    
    
  • Lack of sweating over one-half of your face
    
    
  • Nasal stuffiness
    
    
  • Facial and eye redness
  
  
• A doctor should complete an initial examination of your nerve response. But doctors reserve more extensive testing, such as a CT scan or MRI, for people in whom they suspect a more serious condition:
  
  
  • Skull or brain tumor
    
    
  • Infection
    
    
  • Neurological condition
    
    
  • A doctor may also advise you that a lumbar puncture ("spinal tap") is needed. This may help to establish if the cause of the headache is from an infection, or from bleeding in or around your brain.