Cluster headaches

Question 1

Define

Answer 1

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

TWO types of cluster headaches:

• Episodic - occurring 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
• Chronic - occurring 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 2

Causes

Answer 2

UNKNOWN aetiology

Genetic factor implicated

Question 3

Epidemiology

Answer 3

More common in MEN

Usually occurs between 20-40 yrs

Question 4

Symptoms and signs

Answer 4

Pattern of Occurrence

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

Nature of Symptoms

• Pain comes on rapidly over around 10 mins
• Pain is intense, sharp and penetrating
• Pain is centred 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
• Associated autonomic features:
  
  1. Ipsilateral lacrimation
  2. Rhinorrhoea
  3. Nasal congestion
  4. Eye lid swelling - red
  5. Facial swelling
  6. Flushing
  7. Conjunctival injection
  8. Partial Horner’s syndrome
• Patients find it difficult to stay still and will pace around, occasionally banging their heads on things

Triggers

• ALCOHOL - major precipitant
• Exercise and solvents
• Sleep disruption

Question 5

Investigations

Answer 5

CLINICAL diagnosis based on history

Neurological examination may be useful