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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [26] Cluster Headaches > Flashcards

[26] Cluster Headaches Flashcards

1
Q

What is a cluster headache?

A

Recurrent severe headaches on one side of the head

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2
Q

Where do cluster headaches typically occur?

A

Unilaterally around the eye

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3
Q

What are cluster headaches accompanied by?

A

Ipsilateral autonomic features

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4
Q

What are cluster headaches described as?

A

One of the most painful conditions

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5
Q

What can cluster headaches be classified as?

A
  • Episodic

- Chronic

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6
Q

What are episodic cluster headaches?

A

Occurring in periods lasting from 7 days to one year with pain free periods lasting a month or longer

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7
Q

How long do episodic cluster headache periods usually last?

A

2 weeks - 3 months

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8
Q

What are chronic cluster headaches?

A

Occurring for one year without remissions or remissions of less than 1 month

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9
Q

How can chronic cluster headaches arise?

A

De novo or from episodic cluster headaches

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10
Q

What is thought to underly cluster headaches?

A

Hypothalamic dysfunction and vascular changes

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11
Q

What are the risk factors for cluster headaches?

A
  • Tobacco smoke

- Family history

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12
Q

When do cluster headaches typically occur?

A

Once every 1/2 years for 6-12 weeks around the same time of year

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13
Q

What time of day do cluster headaches typically occur?

A

Usually at night 1-2 hours after falling asleep

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14
Q

What % of patients have chronic cluster headaches with no remission?

A

10-15%

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15
Q

Over what period do cluster headaches come on?

A

10 mintes

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16
Q

What sort of pain is felt in cluster headaches?

A

Constant, sharp, excruciating, penetrating

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17
Q

Where do cluster headaches centre?

A

Around the eye, temple or forehead

18
Q

Are cluster headaches typically uni- or bi-lateral?

A

Unilateral

19
Q

How long do cluster headaches usually last?

A

45-90 minutes

20
Q

What are the associated autonomic features seen in cluster headaches?

A
  • Ipsilateral lacrimation
  • Rhinorrhoea
  • Nasal congestion
  • Eyelid swelling
  • Facial sweating or flushing
  • Conjunctival injection
  • Partial Horner’s syndrome with miosis and ptosis
21
Q

What may accompany the pain and autonomic features of cluster headaches?

A

Nausea

22
Q

How does nausea in cluster headaches compare to migraines?

A

Not as bad

23
Q

How may patients react to cluster headaches?

A

Pace around occasionally banging their heads on walls and furniture

24
Q

What are the possible triggers for cluster headaches?

A
  • Alcohol
  • Histamine
  • Heat
  • Exercise
  • Solvents
  • Disruption to sleep patterns
25
Q

How are cluster headaches usually diagnosed?

A

Clinically from history and examination

26
Q

What are the differentials for cluster headaches?

A
  • Paroxysmal hemicrania

- Short-lasting unilateral neuralgiform headache attacks

27
Q

What general advise should be given to patients with cluster headaches?

A
  • Be prepared for attacks
  • Stop smoking
  • Abstain from alcohol during attacks
  • Maintain good sleep routine and hygiene
28
Q

How can patients prepare for cluster headache attacks?

A

Have acute and preventative medications available

29
Q

What are the recommended treatments for acute attacks of cluster headaches?

A
  • Sumatriptan

- Oxygen 100%

30
Q

What dose of sumatriptan is given in cluster headaches?

A

6mg SC

31
Q

What are some other possible treatments for acute attacks of cluster headaches?

A
  • Ergotamine
  • Anti-inflammatories
  • Metaclopramide
  • Lidocaine intranasally
32
Q

What is the first line prophylaxis for cluster headaches?

A

Verapamil

33
Q

What are the side-effects of verapamil?

A
  • Constipation

- Flushing

34
Q

What other medication can be used as prophylaxis for cluster headaches?

A

Prednisolone

35
Q

How is prednisolone started in cluster headaches?

A

At full dose and reduced after 2-5 days by 10mg increments every 2-3 days

36
Q

How long is prednisolone used as prophylaxis for cluster headaches?

A

2-3 weeks

37
Q

What are some other other options for prophylaxis of cluster headaches?

A
  • Lithium
  • Sodium valproate
  • Ergotamine
  • Deep brain stimulation
  • Surgery
  • Invasive procedures
38
Q

When can ergotamine be used to prevent cluster headaches?

A

2 hours prior to attack

39
Q

When is deep brain stimulation used to treat cluster headaches?

A

In chronic, intractable cluster headaches

40
Q

What surgery can be used to treat cluster headaches and why?

A

Trigeminal nerve block if medical therapy does not help

41
Q

What more invasive procedures can be used to treat cluster headaches as a last resort?

A

Chemical or physical ablation of parts of the trigeminal nerve

42
Q

What is the main complication of cluster headaches?

A

Significant impact on quality of life

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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