Cluster headache Flashcards
What is the prevalence of cluster headaches?
1 in 1000
Which sex do cluster headaches more commonly present in?
male
When is the peak age of onset for cluster headache?
20-40 y/o
What are episodic cluster headaches?
cluster headaches that occur in periods lasting from 7 days to a year separated by pain-free periods of a least a month (cluster periods usually last between 2 weeks and 3 months)
What are chronic cluster headaches?
cluster headaches that last for one year with no remissions
What are the symptoms of cluster headaches?
- rapid onset of excruciating pain around one eye (no aura)
- eye may become swollen, watery, bloodshot, lacrimation,
- facial flushing
- rhinorrhoea (runny nose)
- pain is strictly unilateral
- lasts 15-180 minutes
- occurs once or twice daily (often nocturnal)
- mitosis+/- ptosis (pupil constriction +/- eyelid drooping)
What are triggers for cluster headaches?
Alcohol(potent trigger) histamines nitroglycerine heat exercise solvents disruptions to sleep patterns
What is the diagnostic criteria for cluster headaches?
At least 5 headaches fulfilling the following criteria:
- severe or very severe unilateral, orbital, supraorbital +/- temporal pain lasting 15-180 minutes if untreated
- headache accompanied by ipsilateral cranial autonomic features +/- restlessness/agitation
- attacks have frequency from 1 every other day to 8 a day
- not attributed to another disorder
What are red flags to search for secondary cause or cluster headache?
- change in headache pattern
- new headache onset > 50
- onset of seizures
- headache with systemic illness
- personality change
- symptoms characteristic of increased ICP
- acute onset of worst headache ever
what is the management of an acute attack of cluster headaches?
100% O2 for around 15 minutes via a non-rebreathe mask
SC sumatriptan - 6mg at onset
What are preventative medicines for cluster headache?
suboccipital steroid injections
verapamil (CCB)
lithium
melatonin
