Cluster Headaches

Question 1

What is a cluster headache?

Answer 1

Recurrent severe headaches on one side of the head

Question 2

Where do cluster headaches typically occur?

Answer 2

Unilaterally around the eye

Question 3

What are cluster headaches accompanied by?

Answer 3

Ipsilateral autonomic features

Question 4

What are cluster headaches described as?

Answer 4

One of the most painful conditions

Question 5

What can cluster headaches be classified as?

Answer 5

• Episodic

- Chronic

Question 6

What are episodic cluster headaches?

Answer 6

Occurring in periods lasting from 7 days to one year with pain free periods lasting a month or longer

Question 7

How long do episodic cluster headache periods usually last?

Answer 7

2 weeks - 3 months

Question 8

What are chronic cluster headaches?

Answer 8

Occurring for one year without remissions or remissions of less than 1 month

Question 9

How can chronic cluster headaches arise?

Answer 9

De novo or from episodic cluster headaches

Question 10

What is thought to underly cluster headaches?

Answer 10

Hypothalamic dysfunction and vascular changes

Question 11

What are the risk factors for cluster headaches?

Answer 11

• Tobacco smoke

- Family history

Question 12

When do cluster headaches typically occur?

Answer 12

Once every 1/2 years for 6-12 weeks around the same time of year

Question 13

What time of day do cluster headaches typically occur?

Answer 13

Usually at night 1-2 hours after falling asleep

Question 14

What % of patients have chronic cluster headaches with no remission?

Answer 14

10-15%

Question 15

Over what period do cluster headaches come on?

Answer 15

10 mintes

Question 16

What sort of pain is felt in cluster headaches?

Answer 16

Constant, sharp, excruciating, penetrating

Question 17

Where do cluster headaches centre?

Answer 17

Around the eye, temple or forehead

Question 18

Are cluster headaches typically uni- or bi-lateral?

Answer 18

Unilateral

Question 19

How long do cluster headaches usually last?

Answer 19

45-90 minutes

Question 20

What are the associated autonomic features seen in cluster headaches?

Answer 20

• Ipsilateral lacrimation
• Rhinorrhoea
• Nasal congestion
• Eyelid swelling
• Facial sweating or flushing
• Conjunctival injection
• Partial Horner’s syndrome with miosis and ptosis

Question 21

What may accompany the pain and autonomic features of cluster headaches?

Answer 21

Nausea

Question 22

How does nausea in cluster headaches compare to migraines?

Answer 22

Not as bad

Question 23

How may patients react to cluster headaches?

Answer 23

Pace around occasionally banging their heads on walls and furniture

Question 24

What are the possible triggers for cluster headaches?

Answer 24

• Alcohol
• Histamine
• Heat
• Exercise
• Solvents
• Disruption to sleep patterns

Question 25

How are cluster headaches usually diagnosed?

Answer 25

Clinically from history and examination

Question 26

What are the differentials for cluster headaches?

Answer 26

- Paroxysmal hemicrania | - Short-lasting unilateral neuralgiform headache attacks

Question 27

What general advise should be given to patients with cluster headaches?

Answer 27

- Be prepared for attacks - Stop smoking - Abstain from alcohol during attacks - Maintain good sleep routine and hygiene

Question 28

How can patients prepare for cluster headache attacks?

Answer 28

Have acute and preventative medications available

Question 29

What are the recommended treatments for acute attacks of cluster headaches?

Answer 29

- Sumatriptan | - Oxygen 100%

Question 30

What dose of sumatriptan is given in cluster headaches?

Answer 30

6mg SC

Question 31

What are some other possible treatments for acute attacks of cluster headaches?

Answer 31

- Ergotamine - Anti-inflammatories - Metaclopramide - Lidocaine intranasally

Question 32

What is the first line prophylaxis for cluster headaches?

Answer 32

Verapamil

Question 33

What are the side-effects of verapamil?

Answer 33

- Constipation | - Flushing

Question 34

What other medication can be used as prophylaxis for cluster headaches?

Answer 34

Prednisolone

Question 35

How is prednisolone started in cluster headaches?

Answer 35

At full dose and reduced after 2-5 days by 10mg increments every 2-3 days

Question 36

How long is prednisolone used as prophylaxis for cluster headaches?

Answer 36

2-3 weeks

Question 37

What are some other other options for prophylaxis of cluster headaches?

Answer 37

- Lithium - Sodium valproate - Ergotamine - Deep brain stimulation - Surgery - Invasive procedures

Question 38

When can ergotamine be used to prevent cluster headaches?

Answer 38

2 hours prior to attack

Question 39

When is deep brain stimulation used to treat cluster headaches?

Answer 39

In chronic, intractable cluster headaches

Question 40

What surgery can be used to treat cluster headaches and why?

Answer 40

Trigeminal nerve block if medical therapy does not help

Question 41

What more invasive procedures can be used to treat cluster headaches as a last resort?

Answer 41

Chemical or physical ablation of parts of the trigeminal nerve

Question 42

What is the main complication of cluster headaches?

Answer 42

Significant impact on quality of life