Condition- cluster headaches Flashcards
What are cluster headaches?
A neurological disorder causing acute recurrent unilateral headaches normally around one eye. They have aan annual recuring pattern over a period of several weeks.
Thought to be one of the most painful conditions!!
List the three cardinal features of cluster headaches
- Trigeminal distribution of the pain
- Ipsilateral cranial autonomic symptoms
- Circadian/circannual pattern of attacks
List some of the theorised causes of cluster headaches
UNKNOWN Aetiology but is associated with:
- Superficial temporal artery smooth muscle hyperreactivity to 5-HT
- Grey matter abnormalities
- Autosominal dominant gene may have a role
List some of the risk factors associated with cluster headaches
- Alcohol
- Strong smells
- Sleep distrubance/ apneoa
- FHx
But non of these have a significant causal relationship
Describe the epidemiology of cluster headaches (gender and age)
- Most common in males (5:1 ratio)
- Occurs between 20-40 years
Descibe the timing of cluster headache episodes
ACUTE RECURRENT
- Episodes last 15mins - 3hrs
- Can have multiple episodes a day
- Episodes recur for 4-12 weeks
- Then they disappear but come back a year or so later
What is the difference between chronic and episodic cluster headaches?
- EPISODIC: At least 2 cluster periods lasting 7 to 365 days and separated by pain-free remission periods lasting at least 1 month
- CHRONIC: Attacks occur over more than 1 year without remission periods or with remission periods lasting less than 1 month.
Describe the pain associated with cluster headaches
- S: Pain centred around eye, temple or forehead + unilateral
- O: sudden onset
- C: Intense, sharp, piercing pain (not dull)
- R: X- unilateral side may swap
- A: autonomic symptoms
- T: Pain lasts 15mins - 3hrs. Mutliple daily + cyclical timing
- E: alcohol, sleep, volatile smells, temp
- S: sever- considered one of the most painful conditions
SO PAINFUL THAT PTS DISTRACT THEMSELVES BY BANGING HEAD ETC.
Apart from pain, people suffereing from Cluster headaches suffer from a group of other associated symptoms- what are they and list some examples
AUTONOMIC SYMTPTOMS: (Thought to be caused by trigeminal nerve activation)
- EYES:
- Blood shot eye
- Ipsilateral lacrimation
- Lid oedema (ptosis)
- Miosis = partial Horner’s
- Conjuctival infection
- NOSE:
- Rhinorrhoea
- Nasal Congestion
- FACE:
- Flushing
- Facial swelling
Which investigations could you order to diagnose someone with cluster headaches?
Purely CLINICAL diagnosis based on history
Could do neurological examination (to asses autonomic symptoms)