cluster headache Flashcards
which nerve is responsible for cluster headaches?
trigeminal nerve
what is the 5th cranial nerve?
what are the three divisions of this nerve?
trigeminal nerve
ophthalmic
maxillary
mandibular
define cephalgia?
headache
what type of cephalgia is cluster headache?
trigeminal autonomic cephalgia
is PNS or CNS responsible for cluster headache?
PNS
in a cluster headache what happened to the sensitivity of the trigeminal nerve reflex arc?
increased sensitivity
is vascular dilation or vascular constriction responsible for this headache?
dilation
nociceptive info from the trigeminal nerve travels to what nucleus?
where is said nucleus located in brain?
trigeminocervical complex
brainstem
risk factors for cluster headache?
-5
Male (3x) Age: 20 – 40 FHx Smoker Alcohol excess
is male or female more likely to have cluster headache?
male
which age group is more likely to have cluster headache?
20-40
is obesity or smoking a risk factor?
smoking
are these headaches severe or mild?
severe
how long do cluster headaches last for?
15min-3hours
is pain unilateral or bilateral?
unilateral
which organ of the face is there a lot of pain?
eye
why is it called a cluster headache?
because headaches occur in cluster
how long might a cluster of these headaches last for?
- give typical time range
2weeks to 3 months
pt is suffering from cluster headaches.
how many attacks will they have in one day?
- give typical range
1-8 attacks/day
what is the least remission time between episodes of cluster headaches?
1 month
which ophthalmological condition must be a differential for a pt with a typical cluster headache Hx?
acute glaucoma
to which sensory stimulus does a person become agitated and restless?
what is this called?
light
photophobia
non-autonomic symptoms of cluster headaches?
unilateral orbital pain/temporal pain
N&V
photophobia
autonomic symptoms of cluster headache?
-5
Lacrimation Rhinorrhoea Ptosis Miosis conjunctival injection
are autonomic symptoms unilateral or bilateral?
unilateral
are autonomic symptoms contralateral or ipsilateral?
ipsilateral
simply put why do these autonomic symptoms occur?
↑↑↑ PNS activity
medical word for flow of tears?
etymological root of above word?
lacrimation
lacrima (latin) = tear
droopy eyelid is called what?
ptosis
contraction of the pupil is called what?
etymological root of above word?
dilation of the pupil is called what?
miosis
muein (greek) = shut eyes
mydriasis
cluster headache diagnosis is what type of diagnosis?
clinical diagnosis
pt comes to GP with typical cluster headache Hx and signs.
what must GP do for all such patients?
refer everyone to neurologist
Why might you do an ESR Ix?
rule out giant cell arthritis
why might you do an MRI of brain?
rule out pituitary adenoma or any brain lesion
prophylactic treatment of cluster headache?
-strength, route, frequency
verapamil
80mg
orally
tds
what drug is given prophylactically to treat cluster headaches?
moa of this drug?
verapamil
Ca2+ channel blocker
the prophylactic drug for cluster headache is more commonly used to treat what conditions?
-2
high blood pressure
angina
the prophylactic drug for cluster headaches is taken via what route?
orally
the prophylactic drug for cluster headaches is taken how many times a day?
3x/day
the prophylactic drug for cluster headaches is of what strength?
80mg
what is the acute Mx for cluster headaches?
-2
triptans + O2
which triptan is likely given?
sumatriptan
by what route should the triptan definitely not be given?
oral
by what route can the triptan be given?
-2
subcutaneously
intra-nasally
pt with acute cluster headache.
which drug should definitely not be given?
-4
paracetamol
NSAIDs
opioids
ergots
pt with acute cluster headache in hospital.
O2 is given.
via what mask is it given?
non-rebreather mask
pt with acute cluster headache in hospital.
O2 is given.
how long is it given for?
15 minutes
pt with acute cluster headache in hospital.
O2 is given.
what is the strength of O2 given?
100% at 12-15L/minutes
what side effect can occur from overusing triptans?
what should do if you get this side effect?
overuse headache
taper down triptans
moa of triptans?
effect of this drug in the brain?
-2
5HT agonist
vasoconstricts cerebral blood vessels +
serotonin inhibits nerve firing
which neurotransmitter is essentially being exploited to alleviate symptoms?
what does this neurotransmitter do at the synapse to help stop symptoms?
serotonin
inhibits neuropeptide release at synapse so less nerve firing
what is prognosis for cluster headache?
variable
some better, some better with age, some do not improve
is prognosis easy or hard to predict?
difficult to predict
