CLUSTER HEADACHE

Question 1

what is the clinical presentation of a cluster headache?

Answer 1

severe unilateral periorbital pain, occurring daily (15min-3hrs) for 4-8 weeks, accompanied by one or more ipsilateral sx.

often starts at night, wakes pt.

Question 2

what are the common ipsilateral sx that accompany cluster headaches?

Answer 2

at least one or more of:
- nasal congestion &/or rhinorrhea.
- conjunctival injection &/or lacrimation
- forehead sweating (w/o Horner syndrome)
- Horner syndrome

Question 3

what is horner syndrome? when does it typically present?

Answer 3

eyelid ptosis, pupil miosis, anhidrosis.
during cluster headache, brain mass, or stroke.

Question 4

what might a physical exam of a cluster headache look like?

Answer 4

normal except possible Horner syndrome

Question 5

how do you diagnose a cluster headache?

Answer 5

clinical diagnosis. no imaging findings.

Question 6

what is the symptomatic therapy for a cluster headache?

Answer 6

ORAL MEDS ARE NOT EFFECTIVE!!

initial trx - 100% O2, 12-15L/min on NRB for 15 min

SubQ sumatriptan (or intranasal)

Question 7

what is the preventive therapy for a cluster headache?

Answer 7

important to start preventive therapy immediately (don’t wait a month to diagnose)