(!) Cluster Headache Flashcards
Aetiology and risk factors of cluster headache
Brian is insinate-no pain receptor in itself. Its the blood vessels, cranium, dura and musculature that actually sense and cause the pain. eyes. ears, etc
Cause is unknown for cluster headaches-and the pain usually refers to the eyes or temporal area
The cardinal signs of cluster headaches are
Trigeminal distribution of the pain
Ipsilateral cranial autonomic symptoms
Circadian/circannual pattern of attacks.
Risk factors
Men, head trauma, smoking, alcohol, sleep apnea
10% of headaches, 1/500 of people
Signs and Sx of Cluster headache
Cluster headache-unimaginable pain, lasting 15-180 mins
Unilateral headache with eye involvment (blood, tears, vision)
rarely- parital Horners
Pain affectes 1 side (often same side), and happens a few times a day for 4-12 weeks, then goes away for months or years
Excruciating pain around 1 eye that becomes bloodshot, red, swollen, lacrimation, rhinnrhoa, and occasional ptosis
Often associated with nausea and vomiting, photophobia, sonophobia and migraine like auras
RED FLAGS for headaches:
Any NEW headache after 50-secondary-scary
Onset-very abrupt and severe (thunderclap)
Temporal-progressive severe or increasing severity
Pattern-change in headache pattern/type
Neuro signs-stiff neck, focal sign, confusion, altered LOC
Systemic-abnormal exam, fever, weight loss
Triggers-posture, valsalva coughing, exertion
secondary risk factors-systemic disease, cancer, HIB, 3rd trimester, recent head injuryU
Investigations of cluster headache
Want to see if anything sinister is causing those heachaches, especially if recently developed
CT/MRI head-should be normal if primary headache.
Secondary causes can show-tumour, bleeds, infections
ESR-should be normal. want to exclude giant cell arteritis
Pit function test-should be normal. abnormal can suggest Pit adenoma
Management of cluster headache
acute episode-
triptans- either oral, nasal, subcut- Sumatriptan can be all 3
pure O2 therapy can help- mask around 12L/min
Reccurence- protect with verapramil (1st line) Topiramate, Lithium, Melatonin (2nd line)
can use surgery after all option, implanting a occipital nerve stimulation (ONS) or Deep Brain stim (DBS) device
complications and prog of cluster headache
No complications (depression maybe)
Prog- improves with age
