Cluster Headache

Question 1

What is the pattern of cluster headaches?

Answer 1

Episodic attacks

• 1-7x a day
• 15-180mins
• come on suddenly

Question 2

What are the clinical features of cluster headaches?

Answer 2

Unilateral pain focused around an eye

Agitation

Autonomic features

• ptosis
• swelling
• lacrimation
• rhinorrhoea
• sweating

Question 3

What are the risk factors for cluster headaches?

Answer 3

Male 
Family history 
Head injury 
Smoking 
High alcohol intake

Question 4

What is the pathophysiology of cluster headaches?

Answer 4

Trigemino-parasympathetic reflex

- trigeminal signals triffer the parasympthatic system

Question 5

What tests should be done in a suspected cluster headache?

Answer 5

Head CT
- rule out secondary causes

ESR
- rule out GCA

Pituitary function tests
- rule out secondary causes

Question 6

How are acute cluster headaches managed?

Answer 6

SC sumatriptan
Home oxygen

Prednisolone - reduce attach frequency

Question 7

How can cluster headaches be prevented?

Answer 7

Verapamil

- ensure normal ECG

Question 8

What lifestyle advice should be given to patients?

Answer 8

Smoking cessation

Taper off medications when headaches stop

Avoid triggers

Question 9

How should cluster headaches be monitored?

Answer 9

Referred to a neurologist

Regular ECG on verapamil