cluster headache Flashcards
cluster headache - severity of pain, how long it lasts, duration
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
symptoms of cluster headache
- 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
can ibuprofen and paracetamol help cluster headaches
no they rarely respond to standard analgesics
1st line for treatment cluster headache + alternatives
hint work crush
sumatriptan given by SC injection
if unsuitable, sumatriptan or zolmitriptan nasal spray (unlicensed)
alternatively 100% oxygen at a rate of 10-15L/min for 10-20 mins is useful in aborting an attack
when is prophylaxis of cluster headache considered
if attacks are frequent, last over 3 weeks, or if they cannot be treated effectively
these two drugs are used unlicensed for prophylaxis of cluster headache
verapamil
lithium
this can be used for short term prophylaxis of episodic cluster headache either as monotherpy or in combo with verapamil during verapamil titration
prednisolone
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?
pizotifen
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.
MAOIs e.g. phenelzine, isocarboxazid, tranylcopromine
