cluster headache

Question 1

cluster headache - severity of pain, how long it lasts, duration

Answer 1

severe attacks of pain
can last long periods (weeks. months etc)
can happen multiple times a day
may stop for a while (weeks, months, years), or there may be no gap between them

Question 1

symptoms of cluster headache

Answer 1

• sharp, burning or piercing pain usually on 1 side of head, around eye
• happen at same time of year or at set times of day
• start at stop quickly without warning
• pain can make you feel restless, may want to walk around or move body
• headache last between 15 mins and 3 hours
• sometimes red and watering eye on same side as pain, feeling sick, drooping and swelling in eyelid on same side as pain, smaller pupil in eye on same side as pain, face sweating, blocked or runny nose

Question 2

can ibuprofen and paracetamol help cluster headaches

Answer 2

no they rarely respond to standard analgesics

Question 3

1st line for treatment cluster headache + alternatives

hint work crush

Answer 3

sumatriptan given by SC injection: Initially 6 mg for 1 dose, followed by 6 mg after at least 1 hour if required, to be taken only if headache recurs. max 12mg daily

if unsuitable, sumatriptan or zolmitriptan nasal spray (unlicensed)
e.g. sumatriptan 10–20 mg, dose to be administered into one nostril, followed by 10–20 mg after at least 2 hours if required, to be taken only if headache recurs

alternatively 100% oxygen at a rate of 10-15L/min for 10-20 mins is useful in aborting an attack

Question 4

when is prophylaxis of cluster headache considered

Answer 4

if attacks are frequent, last over 3 weeks, or if they cannot be treated effectively

Question 5

these two drugs are used unlicensed for prophylaxis of cluster headache

Answer 5

verapamil
lithium

Question 6

this can be used for short term prophylaxis of episodic cluster headache either as monotherpy or in combo with verapamil during verapamil titration

Answer 6

prednisolone

Question 7

this is a sedating antihistamine that is used for prevention of vascular, cluster headache and classical, common migraine. also prophylaxis of migraine. what is it?

Answer 7

pizotifen

Question 8

all interactions with the sedating antihistamine pizotifen is to do with sedation. however, for this drug class, avoid due to increased risk of antimuscarinic adverse effects.

Answer 8

MAOIs e.g. phenelzine, isocarboxazid, tranylcopromine