Cluster Headache

Question 1

Define Cluster Headaches

Answer 1

Recurrent, unilateral, severe headaches that typically surround the orbital area

Question 2

Risk factors for Cluster Headaches

Answer 2

Male
Head trauma
Smoking
Heavy alcohol intake
Family history

Question 3

What are the cardinal symptoms of Cluster Headaches

Answer 3

1. Trigeminal distribution of pain
2. Ipsilateral cranial autonomic symptoms
3. Circadian/circannual pattern of attacks

Question 4

Symptoms of Cluster Headaches

Answer 4

Headache (Sudden onset | unilateral, peri-orbital/supra-orbital/temporal | severe 10/10 | sharp | Occurs in clusters, with cyclical periodicity | 15-180 mins | disabling

Autonomic dysfunction: Rhinorrhoea | watery eye/lacrimation | nasal congestion | partial Horners (ptosis + miosis)

Agitation and restlessness
Nausea + vomiting
Photophobia or phonophobia

Question 5

Investigations for Cluster Headaches

Answer 5

Clinical diagnosis, often normal between attacks

Exclude:
CT/MRI: exclude tumour
ESR: exclude GCA
Pituitary function: exclude pituitary adenoma
Polysomnogram: exclude sleep apnoea
ECG: for management

Question 6

Management for acute cluster headaches

Answer 6

First line: sumatriptan SC/IN
Second line: zolmitriptan, lidocaine, corticosteroids
CVD: lidocaine + corticosteroids

+ Oxygen, 100% high flow 12-15L/min non-rebreather for 15-20 minutes

Question 7

Management for chronic cluster headache

Answer 7

Verapamil
Lithium
Topiramate
Gabapentin
Melatonin
Valproate sodium
Surgery