Headache, Cluster

Notes
  • Cluster headache is one of the most painful conditions known to mankind
  • Triggers of cluster headache include: alcohol, strong smelling substances, warm temperatures, exercises, naps during the day and nitroglycerine
  • Cluster headache belongs to a group of primary headache disorders, classified as the trigeminal autonomic cephalalgias or (TACs)

Statistics: the prevalence of cluster headache globally is 0.1- 0.2%; it attacks those ≥ 20yrs; it is 5-6 times more common in men than in women 

Symptoms
  • Unilateral (one sided) pain
  • The pain is normally centered over one eye, one temple or the forehead (though it can occasionally spread to other areas).
  • It is mostly experienced at a similar time each day
  • In most cases, the headache starts at night, 1-2 hours after retiring to bed.
  • The pain reaches the climax within 5 - 10 minutes, lasts for 30 - 60 minutes and then stops suddenly.
  • In a case of episodic cluster headache (80% of all cluster headaches), the attacks last only for 4 to 12 weeks once a year, however, in chronic cluster headache (20% of all cases) the attacks occur throughout the year.
  • Other symptoms include: blocked or running nose, a drooping eyelid, watering of one year, redness of one eye and a flushed or sweating face.
Diagnosis
  • Clinical review
  • MRI (to rule out other possible causes)
Differential
  • Migraine headache
  • Tension headache
  • Sinusitis
  • Chronic paroxysmal hemicrania
  • Trigeminal neuralgia
  • Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)
Prevention
  • Corticosteroids such as prednisolone (for 8-10 days)
  • Verapamil
  • Methysergide (not to be used for more than 6 months)
  • Lithium
  • Topiramate
  • Ergotamine (not widely used)
  • Cessation of smoking
Management
  • Oxygen (home oxygen treatment)
  • Sumatriptan self-injections (tablets are less effective)
  • Sumatriptan nasal sprays
  • Zolmitriptan nasal sprays
  • Surgery
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