Misdiagnosis of cluster headache

Abstract

Misdiagnosis of cluster headache is common in clinical practice and can lead to significant morbidity. The International Headache Society has published diagnostic criteria that are generally straightforward and useful, but careful understanding of these criteria and how to handle exceptions is necessary. The primary diagnostic points involve severity, length, and frequency of individual headache attacks, as well as the presence of ipsilateral autonomic features. Such additional features as time cycling of headache clusters, physical characteristics of patients, and response to treatment may prove useful in individual cases, but must not be relied on too much.

Medicolegal issues in cluster headache

“…In two of these cases, CH was an incidental condition of no relevance to the case matter [6,9]. The Medline search identified three articles of general relevance to legal liability in CH [12,13••,14] and three case reports [15][16][17] involving potential legal issues; the authoritative textbooks identified two anecdotes and case reports [18,19] regarding potential legal liability in cases of CH. In addition, the circumstances of two malpractice cases involving CH are known to the first author, who was approached to act as an expert defense witness.…”

“…When cases and anecdotes from every source were considered as a whole, three involved issues related to diagnosis [13••,20,21], six involved risks inherent to the disease [3,10,14,16,18,19], four involved treatment side effects [5,12], none involved research issues, six involved issues related to disability determination [2,4,7,8,11,22], and two involved legal cases in which CH was mentioned, but was not a relevant issue in the case [6,9]. One case involved issues related to diagnosis and risks inherent in the disease [15] and one involved issues This paper identifies legal issues of relevance to the diagnosis and treatment of cluster headache, including areas of actual and potential malpractice liability. Legal topics that are relevant to cluster headache can be divided into five categories: diagnostic-related issues, risks inherent in the disease process, prescribing and treatment-related problems, research-related issues, and disability determination.…”

“…Legal appeals decision [2] LexisNexis* Disability Legal appeals decision [3] LexisNexis Risks inherent in disease Legal appeals decision [4] LexisNexis Disability Legal appeals decision [5] LexisNexis Treatment side effects Legal appeals decision [6] LexisNexis Not relevant Legal appeals decision [7] LexisNexis Disability Legal appeals decision [8] LexisNexis Disability Legal appeals decision [9] LexisNexis Not relevant Legal appeals decision [10] LexisNexis Risks inherent in disease Legal appeals decision [11] LexisNexis Disability Pending case [21] Google Diagnosis Administrative case [22] Google Disability Case report [15] Medline Diagnosis and risks inherent to disease Case report [17] Medline Diagnosis and access to care Case series [3] Medline Risks inherent in disease Case series [4] Medline Diagnosis Case report [16] Medline Risks inherent in disease Journal article [12] Medline Treatment side effects Case report [20] Medline Diagnosis Book chapter [18] Textbook search Risks inherent in disease Book chapter [19] Textbook search Risks inherent in disease Two malpractice cases Author's clinical experience Treatment side effects *LexisNexis Group, Dayton, OH.…”

“…One expert has commented that early diagnosis can be lifesaving because CH is a "secondarily deadly" syndrome as a result of the risk that poorly controlled headaches will lead to suicide. That expert described a case, discussed in detail in a later section, to support this contention [15]. In addition, erroneous diagnosis and subsequent unnecessary surgical or dental treatments may cause injury.…”

“…Delayed diagnosis of cluster headache No legal case was identified in which delayed diagnosis of CH was alleged, but informal anecdotal reports of such delay are common; one identified case report involved diagnostic delay [15]. A recent study showed a median time to diagnosis of CH of 3 years, with a range of 1 week to 48 years [13••].…”