Delayed diagnosis of cluster headache in African-American women

The male-to-female ratio has fallen in cluster headache over the last sever al decades and is now 2 1:1. Unfortunately, women still ore not diagnosed a ccurately. This lack of appropriate diagnosis appears related to the miscon ception that cluster headache rarely occurs in women. Compounding this misc onception, there seems to be an ethnic bias. We report cluster headache in five African-American women in whom diagnosis was delayed due to gender, et hnicity, and, most importantly, an inability to make a correct diagnosis of cluster headache. Cluster headache diagnostic criteria are no different in men or women and h ave no ethnic boundaries. Clinical features such as disordered chronobiolog y and abnormal behavior often suggest the diagnosis. Migrainous features oc cur commonly in cluster headache and, when present, should not exclude the diagnosis. likewise, neither race nor sex should exclude the diagnosis. The diagnosis of cluster headache is easily made by considering unilateral orb ital, supraorbital or temporal location; short duration [15-180 minutes, un treated), and ipsilateral autonomic dysfunction involving the eye or nose.