Cluster headache Flashcards
What is trigeminal autonomic cephalgia?
A group of primary HEADACHE disorders characterised by UNILATERAL TRIGEMINAL DISTRIBUTION PAIN that occurs in association with IPSILATERAL CRANIAL AUTONOMIC FEATURES
examples of trigeminal autonomic cephalgia?
4 main types:
-cluster
-Paroxymal hemicrania
-Hemicrania continue
-SUNCT
what headache is often reffered to as a suicide headache?
Cluster headache
-this is because it is so painful
who more commonly gets a cluster headache?
30 to 40s
Smoker
Men> females
when does a cluster headache typically occur?
around sleep
It has seasonal variation
how long does a cluster headache typically last and how often does it occur in a day?
15mins- 3 hours
1 to 8 a day
Cluster bout may last from a few weeks to months
presentation of cluster headache?
15 mins- 3 hours
1 to 8 a day
Cluster bout may last from a few weeks to months
Severe unilateral headache (usually around the eye)
Recurrent attacks of sudden-onset unilateral peri orbital pain
Unilateral:
-watery blood shot eye
-lacrimation
-rhinorrhoea
-miosis (pupil constriction)
-ptosis (eyelid drooping)
-lid swelling
-facial flushing/sweating
acute treatment- cluster headache?
First line= High flow O2
-Triptans (subcut injection sumatriptan 6mg)
-Steroids (reducing course over 2 weeks)
prophylaxis- cluster headache?
verapamil
Lithium
Steroids (reducing course over 2 weeks)
A 47-year-old woman presents to her General Practitioner with a six-week history of frequent, severe headaches that localise around her right eye. During the headaches she notices that her right eye waters and looks red. She also complains of a “runny nose” during these headaches. Her doctor suspects cluster headaches. What is the acute first-line treatment of cluster headaches?
High flow O2
A 30 year old man presents to his GP as he is “unable to cope with one more of these headaches.” He says he has had ten in the last week. They last around 30 minutes each, and during these headaches, which focus around the right eye, he says he experiences ipsilateral lacrimation. Neurological examination shows no physical abnormalities. What is the most likely diagnosis?
Cluster headache
A 37 year old banker presents to the emergency department with a severe headache on the right side of his face, worse around his right eye. On examination, the eye is bloodshot.
What is the best management for this patient?
subcut sumatriptan
A 50-year-old man presents to his General Practitioner with a four-week history of frequent, severe headaches that localise around his left eye. During the headaches he notices that his left eye waters and looks red. His partner also mentions that his left eyelid looks “droopy” during these headaches. He recalled having a similar four-week period of headaches around one year ago. What is the most likely diagnosis?
Cluster headache
A 33-year-old man presents to A&E complaining of right eye pain, which has now resolved at the time of assessment. He reports the pain lasted 30 minutes. It was stabbing and so severe that he was writhing with pain. His eye was watery and became red. His nose was runny. On examination, visual acuity was 6/6 in both eyes, pupils equal and reactive to light with nil abnormality on fundoscopy. On examination, the patient’s pain recurs. His records show that he was seen in A&E one week ago with the same presentation and that this pain was successfully treated with 15L of oxygen.
Which of the following is the most likely diagnosis?
Cluster headache
