Cluster headache

Question 1

Definition

Answer 1

Unilateral intense throbbing pain typically located around one eye with episodes typically once a year, lasting for around 4-12 weeks

Question 2

Symptoms

Answer 2

Unilateral eye pain
Red eye, swollen and watery
Miosis
Ptosis
Sweating
Nasal congestion
Agitated

Question 3

Episodic vs chronic

Answer 3

Episodic: 1 every other day up to 8 per day with remission >1 month
Chronic: 1 every other day up to 8 per day with continuous remission of <1 month in 12 month period

Question 4

Treatment

Answer 4

High flow 100% oxygen
Nasal/SC triptans

Prophylaxis: Verapamil
Other options: Prednisolone, topiramate, lithium, occipital nerve block

Question 5

Investigations

Answer 5

MRI scan with gadolinium contrast is the investigation of choice

Question 6

Triggers

Answer 6

Exercise, lack of sleep, caffeine, smells, alcohol

Question 7

Types of trigeminal autonomic cephalgias and their frequency and duration

Answer 7

SUNCT/SUNA
Duration: Sec-min
Frequency per day: 1- 100s

Paroxysmal hemicrania
Duration: Minutes
Frequency per day: 5 -50

Cluster headache
Duration: Min - hours
Frequency per day: 1-8

Hemicrania continua
Duration: Months
Frequency per day: 1