Cluster Headache

Question 1

Define cluster headache

Answer 1

A neurological disorder characterised by recurrent, severe headaches on one side of the head typically around the eye, tending to recur over a period of several weeks.

Question 2

Explain the aetiology/risk factors of cluster headaches

Answer 2

UNKNOWN aetiology

Genetic factor implicated

Question 3

Summarise the epidemiology of cluster headaches

Answer 3

More common in MEN

Usually occurs between 20-40 yrs

Question 4

Name the 2 types of cluster headache.

Answer 4

TWO types of cluster headaches:

Episodic - occurring in periods lasting 7 days - 1 year, separated by pain-free periods lasting 3 months. Cluster periods usually last between 2 weeks - 3 months

Chronic - occurring for 1 year without remissions or with short-lived remissions of less than a month. Chronic cluster headaches can arise de novo or arise from episodic cluster headaches.

Question 5

Describe the Pattern of Occurrence

Any triggers?

Answer 5

Headaches occur in bouts lasting 6-12 weeks

These occur once every year or once every 2 years, and tends to occur at the same time each year

Headaches typically occurs at night, 1-2 hours after falling asleep

The interval between bouts tends to be the same

10% with episodic cluster headaches go on to develop chronic cluster headaches

Triggers
ALCOHOL - major precipitant
Exercise and solvents
Sleep disruption

Question 6

Describe Presenting symptoms and signs

Answer 6

Pain comes on rapidly over around 10 mins

Pain is intense, sharp and penetrating

Pain is centred around the eye, temple or forehead

Pain is unilateral

Pain typically lasts around 45-90 mins (range: 15 mins - 3 hours)

Pain occurs once or twice daily

Associated autonomic features: 
Ipsilateral lacrimation  
Rhinorrhoea  
Nasal congestion  
Eye lid swelling  
Facial swelling  
Flushing  
Conjunctival injection  
Partial Horner's syndrome  (ptosis)

Patients find it difficult to stay still and will pace around, occasionally banging their heads on things

Question 7

Identify appropriate investigations for cluster headaches

Answer 7

CLINICAL diagnosis based on history

Neurological examination may be useful

Question 8

Mx?

Answer 8

Acute;
Sumatriptan SC and Oxygen
+ transitional therapy; prednisolone po or dihydroergotamine

2nd intranasal zolmitriptan
3rd lidocaine
4th occipital nerve block

Chronic disease:
1st - Verapamil