headache

Question 1

what are cluster headaches?

Answer 1

typically occur in clusters lasting several weeks, with the clusters themselves typically once a year.

Question 2

risk factors for cluster headaches

Answer 2

Alcohol may trigger an attack and there also appears to be a relation to nocturnal sleep.

Question 3

features of cluster headache ?

Answer 3

sharp, stabbing pain around one eye

pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours

patient is restless and agitated during an attack due to severity

clusters typically last 4-12 weeks
accompanied by redness, lacrimation, lid swelling
nasal stuffiness
miosis and ptosis in a minority

Question 4

Investigations

Answer 4

MRI with gadolinium contrast is the investigation of choice

Question 5

Mx of acute cluster headaches ?

Answer 5

100% oxygen (80% response rate within 15 minutes)

subcutaneous triptan (75% response rate within 15 minutes)

Question 6

Prophylaxis of cluster headache ?

Answer 6

verapamil is the drug of choice

there is also some evidence to support a tapering dose of prednisolone