Cluster headache
Meaning of cluster headache: For the purposes of this Statement of Principles, cluster headache: (a) means a headache condition in which there are multiple attacks of severe, unilateral headache in the orbital, supraorbital or temporal region, where each headache typically lasts from 15 to 180 minutes. The headache is accompanied by a sense of restlessness or agitation, or at least one of the following autonomic symptoms occurring on the same side as the pain: (i) conjunctival injection or lacrimation; (ii) eyelid oedema; (iii) forehead and facial sweating; (iv) miosis or ptosis; or (v) nasal congestion or rhinorrhoea; and (b) includes episodic cluster headache and chronic cluster headache; and (c) excludes: (i) headache attributable to inflammatory disorders of the head and neck; (ii) headache attributable to structural abnormalities; (iii) headache attributable to systemic disease; (iv) hemicrania continua; (v) migraine; (vi) paroxysmal hemicrania; (vii) short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT); (viii) short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA); (ix) tension-type headache; and (x) trigeminal neura
Reasonable Hypothesis (RH) — Statement of Principles No. 57 of 2018
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cluster headache or death from cluster headache with the circumstances of a person's relevant service:
- (1)having trauma to the skull or face of the affected side within the seven days before the clinical onset of cluster headache;
Note: trauma to the skull or face is defined in the Schedule 1 - Dictionary.
- (2)having concussion or moderate to severe traumatic brain injury before the clinical onset of cluster headache, where cluster headache has developed within the seven days of: (a) injury to the head; or (b) regaining consciousness following the injury to the head; or (c) discontinuing medication that impairs the ability to sense or report headache following the injury to the head;
- (3)undergoing eye exenteration of the affected side within the two years before the clinical onset of cluster headache;
Note: exenteration is defined in the Schedule 1 - Dictionary.
- (4)having sleep apnoea at the time of the clinical onset of cluster headache;
- (5)smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of cluster headache;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
- (6)using intranasal cocaine at least four times per month for the one year before the clinical onset of cluster headache;
- (7)having sleep apnoea at the time of the clinical worsening of cluster headache;
- (8)smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of cluster headache;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
- (9)taking glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate within the 24 hours before the clinical worsening of cluster headache;
- (10)consuming alcohol within the 24 hours before the clinical worsening of cluster headache;
- (11)being treated with sildenafil within the 24 hours before the clinical worsening of cluster headache;
- (12)inability to obtain appropriate clinical management for cluster headache;
Aggravation-only factors: the factors in subsections 9(7) to 9(12) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 58 of 2018
3 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, cluster headache or death from cluster headache is connected with the circumstances of a person's relevant service:
- (1)taking glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate within the 24 hours before the clinical worsening of cluster headache;
- (2)consuming alcohol within the 24 hours before the clinical worsening of cluster headache;
- (3)inability to obtain appropriate clinical management for cluster headache;
Aggravation-only factors: the factors in subsections 9(1) to 9(3) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
