[26] Cluster Headaches Flashcards
What is a cluster headache?
Recurrent severe headaches on one side of the head
Where do cluster headaches typically occur?
Unilaterally around the eye
What are cluster headaches accompanied by?
Ipsilateral autonomic features
What are cluster headaches described as?
One of the most painful conditions
What can cluster headaches be classified as?
- Episodic
- Chronic
What are episodic cluster headaches?
Occurring in periods lasting from 7 days to one year with pain free periods lasting a month or longer
How long do episodic cluster headache periods usually last?
2 weeks - 3 months
What are chronic cluster headaches?
Occurring for one year without remissions or remissions of less than 1 month
How can chronic cluster headaches arise?
De novo or from episodic cluster headaches
What is thought to underly cluster headaches?
Hypothalamic dysfunction and vascular changes
What are the risk factors for cluster headaches?
- Tobacco smoke
- Family history
When do cluster headaches typically occur?
Once every 1/2 years for 6-12 weeks around the same time of year
What time of day do cluster headaches typically occur?
Usually at night 1-2 hours after falling asleep
What % of patients have chronic cluster headaches with no remission?
10-15%
Over what period do cluster headaches come on?
10 mintes
What sort of pain is felt in cluster headaches?
Constant, sharp, excruciating, penetrating
Where do cluster headaches centre?
Around the eye, temple or forehead
Are cluster headaches typically uni- or bi-lateral?
Unilateral
How long do cluster headaches usually last?
45-90 minutes
What are the associated autonomic features seen in cluster headaches?
- Ipsilateral lacrimation
- Rhinorrhoea
- Nasal congestion
- Eyelid swelling
- Facial sweating or flushing
- Conjunctival injection
- Partial Horner’s syndrome with miosis and ptosis
What may accompany the pain and autonomic features of cluster headaches?
Nausea
How does nausea in cluster headaches compare to migraines?
Not as bad
How may patients react to cluster headaches?
Pace around occasionally banging their heads on walls and furniture
What are the possible triggers for cluster headaches?
- Alcohol
- Histamine
- Heat
- Exercise
- Solvents
- Disruption to sleep patterns
How are cluster headaches usually diagnosed?
Clinically from history and examination
What are the differentials for cluster headaches?
- Paroxysmal hemicrania
- Short-lasting unilateral neuralgiform headache attacks
What general advise should be given to patients with cluster headaches?
- Be prepared for attacks
- Stop smoking
- Abstain from alcohol during attacks
- Maintain good sleep routine and hygiene
How can patients prepare for cluster headache attacks?
Have acute and preventative medications available
What are the recommended treatments for acute attacks of cluster headaches?
- Sumatriptan
- Oxygen 100%
What dose of sumatriptan is given in cluster headaches?
6mg SC
What are some other possible treatments for acute attacks of cluster headaches?
- Ergotamine
- Anti-inflammatories
- Metaclopramide
- Lidocaine intranasally
What is the first line prophylaxis for cluster headaches?
Verapamil
What are the side-effects of verapamil?
- Constipation
- Flushing
What other medication can be used as prophylaxis for cluster headaches?
Prednisolone
How is prednisolone started in cluster headaches?
At full dose and reduced after 2-5 days by 10mg increments every 2-3 days
How long is prednisolone used as prophylaxis for cluster headaches?
2-3 weeks
What are some other other options for prophylaxis of cluster headaches?
- Lithium
- Sodium valproate
- Ergotamine
- Deep brain stimulation
- Surgery
- Invasive procedures
When can ergotamine be used to prevent cluster headaches?
2 hours prior to attack
When is deep brain stimulation used to treat cluster headaches?
In chronic, intractable cluster headaches
What surgery can be used to treat cluster headaches and why?
Trigeminal nerve block if medical therapy does not help
What more invasive procedures can be used to treat cluster headaches as a last resort?
Chemical or physical ablation of parts of the trigeminal nerve
What is the main complication of cluster headaches?
Significant impact on quality of life
