Cluster Headache Flashcards
… headache is a severe primary headache disorder characterised by recurrent unilateral headaches centred on the eye or temporal region.
Cluster headache is a severe primary headache disorder characterised by recurrent unilateral headaches centred on the eye or temporal region.
The lifetime prevalence of … headaches is estimated to be 124 per 100,000 people.
The lifetime prevalence of cluster headaches is estimated to be 124 per 100,000 people.
cluster headaches - onset and gender affected most?
Onset tends to be between the ages of 20-40. Males are affected four times more commonly than females.
The trigeminal autonomic cephalalgias (TACs) are a collection of primary headache disorders characterised by … headache and parasympathetic autonomic features.
The trigeminal autonomic cephalalgias (TACs) are a collection of primary headache disorders characterised by unilateral headache and parasympathetic autonomic features.
TACs are a relatively rare cause of primary headache disorder. There are four distinct forms (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache and hemicrania continua) but they share a number of characteristics:
TACs are a relatively rare cause of primary headache disorder. There are four distinct forms (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache and hemicrania continua) but they share a number of characteristics:
Unilateral pain within the trigeminal distribution
Ipsilateral cranial autonomic features
Paroxysmal hemicrania
Patients with paroxysmal hemicrania (PH) suffer from short (2-30 minutes), severe episodes of unilateral orbital, supraorbital and/or temporal pain. Attacks tend to happen several times over the course of a day.
Ipsilateral autonomic features include conjunctival injection and/or lacrimation, nasal congestion, rhinorrhoea, sweating, miosis/ptosis or eyelid oedema. Alternatively, or in addition, a sense of restlessness or agitation may also be present.
PH resolves completely with the administration of indomethacin (an NSAID).
What is conjunctival injection?
Conjunctival injection or hyperemia is a nonspecific response with enlargement of conjunctival vessels induced by various diseases
Summary of Cluster headache
Cluster headache is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye. There are often accompanying autonomic symptoms during the headache such as eye watering, nasal congestion and swelling around the eye, typically confined to the side of the head with the pain. The are typically treated with inhaled oxygen and sumatriptans
Pathology and causes of cluster headache
One sided headache in ophthalmic nerve distribution region with autonomic symptomatology
Hypothalamus involvement - episodic occurrence of cluster attacks
Posterior hypothalamic activation -> secondary trigeminal stimulation -> afferents to nucleus caudalis - projection to thalamus, sensory cortex - pain perception
Hyper-activation of parasympathetic pterygopalatine ganglion -> autonomic symptoms
Cavernous sinus walls inflammation -> decreased venous flow and injury of internal carotid artery sympathetic fibers
Types of cluster headache (2)
Episodic - daily episodes over 6-12 weeks; “clusters”, followed by remission period up to 12 months
Constant - episodes without substantial remission period
Causes of cluster headache and risk factors?
Unknown; possibly genetic causes
Risk factors include male gender, stressful periods, allergic rhinitis, sexual intercourse, tobacco and excessive alcohol use
Complications of cluster headache?
Progresses episodic -> chronic
Signs and symptoms of cluster headache
Cluster headaches are described in the ICHD-3 as:
‘Attacks of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 minutes and occurring from once every other day to eight times a day. The pain is associated with ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis and/or eyelid oedema, and/or with restlessness or agitation.’
Cluster headaches have been defined in the International Classification of Headache Disorders 3rd edition (ICHD-3).
The following diagnostic criteria are given: (5)
1) At least five attacks fulfilling criteria B-D
2) Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated)
3)Either or both of the following:
- at least one of the following symptoms or signs, ipsilateral to the headache:
A) conjunctival injection and/or lacrimation
B) nasal congestion and/or rhinorrhoea
C) eyelid oedema
D) forehead and facial sweating
E) miosis and/or ptosis
- a sense of restlessness or agitation
4) Occurring with a frequency between one every other day and 8 per day
5) Not better accounted for by another ICHD-3 diagnosis.
Cluster headaches can be further classified into two subtypes:
Episodic: refers to patients where multiple attacks occur within periods lasting 7 days to 1 year but with pain-free intervals of at least 3 months between bouts. This is the more common form accounting for 80-90% of cases.
Chronic: attacks occurring over a period of 1 year or longer without a period of remission greater than 3 months. This accounts for around 10-20% of cases.
