How is cluster headache diagnosed?

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Diagnosing cluster headache is a clinical process based on established diagnostic criteria, not on imaging alone. The hallmark is attacks of severe, unilateral head pain that last 15–180 minutes, occur in clusters, and are accompanied by restlessness or agitation along with ipsilateral autonomic symptoms such as tearing, nasal congestion, eyelid droop, or conjunctival injection. Importantly, the criteria require at least five attacks with this pattern to make the diagnosis, because a single or a few episodes can resemble other headache disorders. Imaging may be used to rule out other causes if red flags appear, but it isn’t used to confirm cluster headache by itself. Bilateral pain is not typical, and the combination of strict unilateral, short, intensely painful attacks with restlessness and ipsilateral autonomic signs best fits the diagnosis described.