Do you have cluster headache? Take the 2-minute quiz
Wondering whether you have cluster headache? Take this 2-minute test. It is not a diagnosis, but a starting point for a conversation with your doctor.
Written by Nicolas Macé, PhD
If you keep getting severe headaches on one side of your head and you are not sure whether they are migraine attacks, cluster headache, or something else, this test gives you a good first answer. The short version: cluster headache causes 15 min to 3 hours-long attacks of extreme pain centered on one eye, and in most people they cause your painful eye to tear up, or your nose on the painful side to run. The result will help you decide what to do next.
- We start with three safety questions, followed by three or four yes or no questions. It takes about two minutes.
- Your answers are processed on your device. We store only the anonymized results, so we can see how many people take it and what results people get.
- The result is not a medical diagnosis. Only a doctor can diagnose a headache disorder.
How this test works
The Erwin Test for Cluster Headache (ETCH) asks about the three features that best separate cluster headache from other headache conditions: how bad the pain is, how long an attack lasts, and whether your eye or nose reacts on one side only. In a validation study, 224 patients at a headache clinic answered the questions themselves on paper, and their results were compared with the independent diagnosis of a headache specialist.[1]
The test correctly identifies 84% of the patients who had cluster headache (84% sensitivity), and correctly cleared 89% of the patients who did not have cluster headache (89% specificity).
A few rarer conditions from the same family (paroxysmal hemicrania, hemicrania continua, SUNCT) can also produce a positive result. See our section on those conditions for more details and how to differentiate them from cluster headache.
The official diagnostic criteria for cluster headache
The International Classification of Headache Disorders (ICHD-3) is the authoritative classification doctors use to diagnose cluster headache and other headache disorders.[2] Below we reproduce the ICHD-3 cluster headache criteria, together with their explanation in plain language:
| Criterion | In plain language |
|---|---|
| (A) At least 5 attacks fulfilling criteria (B–D) | — |
| (B) Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15–180 minutes (when untreated) | Severe or very severe pain in one or more of the following regions: • the eye • above the eye • the temple only on one side of the head, lasting 15 minutes to 3 hours untreated. |
| (C) Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: • conjunctival injection and/or lacrimation • nasal congestion and/or rhinorrhoea • eyelid oedema • forehead and facial sweating • miosis and/or ptosis 2. a sense of restlessness or agitation | During the attack, item (1) or item (2) below, or both, apply to you: 1. On the painful side of the head, one or more of these happen to you: • a red or bloodshot eye, and/or a watering/teary eye • a blocked and/or runny nostril • a swollen or puffy eyelid • sweating on the forehead or face • a smaller (constricted) pupil and/or a drooping eyelid 2. You are restless or agitated |
| (D) Occurring with a frequency between one every other day and 8 per day. (During part, but less than half, of the active time-course, attacks may be less frequent.) | A period of time when you very often have attacks is called a "cluster period". More than half the duration of a cluster period, you have: • an attack every other day, or more frequently; • no more than 8 attacks per day. |
| (E) Not better accounted for by another ICHD-3 diagnosis. | No other headache disorder is a better match, given your symptoms. |
Does the table read like a description of your attacks? Then, take the simple test above if you haven't already, and, even if the result is negative, bring it to a doctor and discuss the possibility that you might have cluster headaches.
About the 2-minute test
The Erwin Test for Cluster Headache was developed by researchers at UTHealth Houston and validated in a study published in Cephalalgia in 2021.[1] Its questions are reproduced verbatim. The instrument is © 2020 The University of Texas Health Science Center at Houston, reproduced here under the CC BY-NC-ND 4.0 license on a non-commercial patient resource. The staged flow above (the follow-up question and how the answers are combined) is ours and was not validated by the original authors.
References
- ↩ Parakramaweera R, Evans RW, Schor LI, Pearson SM, Martinez R, Cammarata JS, Amin AJ, Yoo SH, Zhang W, Yan Y, Burish MJ (2021). A brief diagnostic screen for cluster headache: Creation and initial validation of the Erwin Test for Cluster Headache. Cephalalgia, 41(13), 1298–1309. doi:10.1177/03331024211018138
- ↩ Headache Classification Committee of the International Headache Society (IHS) (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211. doi:10.1177/0333102417738202
Did you find this page helpful?
Disclaimer
The information on this website is provided for educational and harm reduction purposes only. It does not constitute medical advice and should not replace consultation with a qualified healthcare professional. See our Legal page for more details.