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Cluster Headache – Side-Switching Between Bouts — SCE Neurology MCQ

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ModerateHeadache & Facial PainCluster Headache – Side-Switching Between BoutsSCE Neurology

A 40-year-old woman presents with episodic severe periorbital pain lasting 3 hours with ipsilateral ptosis, miosis, lacrimation, and nasal congestion. Between attacks she is entirely normal. She asks whether cluster headache affects one side consistently or can switch sides. What is the correct answer?

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Correct answer: C — Cluster headache is typically side-locked during a bout but may switch sides between bouts in approximately 15% of patients

Cluster headache is typically strictly unilateral and side-locked within a cluster bout (all attacks during one bout affect the same side). However, approximately 15% of patients report side-switching between separate bouts (e.g. right-sided in one cluster period, left-sided in the next). Side-switching within the same bout is very rare and should prompt investigation for secondary causes. A: Side-switching between bouts does occur. C: Alternation within a bout is atypical. D: CH is always unilateral. E: Side-switching between bouts does not exclude CH.

Reference: ICHD-3 (2018); Bahra et al. Cluster Headache Features