Cluster Headache

Question 1

Define Cluster Headache?

Answer 1

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

Question 2

What is the aetiology of Cluster Headache?

Answer 2

Unknown aetiology

Genetic factor implicated

Question 3

What is the epidemiology of Cluster Headache?

Answer 3

More common in MEN

Usually occurs, between 20-40 yrs

Question 4

What are the two types of Cluster Headaches?

Answer 4

Episodic

Chronic

Question 5

What are Episodic Cluster Headaches?

Answer 5

Occuring in periods lasting 7 days - 1 year, separated by pain-free periods lasting a month or longer
Cluster periods usually last between 2 weeks - 3 months

Question 6

What are Chronic Cluster Headaches?

Answer 6

Occuring 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 7

What is the pattern of occurrence of Cluster Headaches?

Answer 7

Headaches occur in bouts lasting 6-12 weeks
These occur once every year or once every 2 years, and tends ot 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

Question 8

What are the nature of symptoms of Cluster Headaches?

Answer 8

Pain comes on rapidly over around 10 mins
Pain is intense, sharp and penetrating
Pain is centered 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
Patients find it difficult to stay still and will pace around, occasionally banging their heads on things

Question 9

What are the associated autonomic features for Cluster Headaches?

Answer 9

Ipsilateral lacrimation
Rhinorrhoea 
Nasal congestion 
Eye lid swelling 
Facial swelling 
Flushing 
Conjunctival injection
Partial Horner's syndrome

Question 10

What are the triggers for Cluster Headaches?

Answer 10

ALCOHOL - major precipitant
Exercise and solvents
Sleep disruption

Question 11

What investigations do we do for Cluster Headaches?

Answer 11

Clinical diagnosis based on history

Neurological examination may be useful