Cluster headache

Question 1

Define cluster headache

Answer 1

Neurological disorder characterised by recurrent, severe headaches on 1 side of the head, typically around the eye, tending to recur over a period of several weeks

Question 2

Classification of cluster headaches

Answer 2

Episodic
Occur in periods lasting 7 days to 1 year, separated by pain free periods lasting 1+ month
Usually last 2 weeks to 3 months

Chronic
Occur for 1 year without remissions or with short lived remission of <1 month
Can arise de novo or from episodic cluster headaches

Question 3

Aetiology of cluster headaches

Answer 3

Unknown

genetic factor implicated

Question 4

Risk factors/triggers of cluster headaches

3

Answer 4

ALCOHOL
Exercise & solvents
Sleep disruption

Question 5

Epidemiology of cluster headaches

gender & age

Answer 5

More common in men

Usually occur between ages 20-40yrs

Question 6

Presenting symptoms & signs of cluster headaches - Pattern of occurrence

Answer 6

Occur in bouts lasting 6-12 weeks
Once every year/2 years
Typically occur at night
Interval between bouts tends to be the same

Question 7

Presenting symptoms & signs of cluster headaches - Nature of symptoms
(6 & 2)

Answer 7

Pain -
Comes on rapidly (10 mins)
Intense, sharp & penetrating
Centred around eye/temple/forehead
Unilateral
Lasts 45-90 mins usually
Occurs 1-2 times daily

Associated autonomic features
Difficulty staying still - pace around, occasionally banging things on head

Question 8

Investigations for cluster headaches

Answer 8

Clinical diagnosis based on history

Neuro exam may be useful