Neurology - cluster headaches

Question 1

Cluster headaches presentation

Answer 1

Very severe unilateral headaches often around the eye

Occur in clusters of headache events over weeks/months followed by pain free period lasting 1-2y

Question 2

What can the headaches be triggered by?

Answer 2

Alcohol
Strong smells
Exercise

Question 3

What other symptoms are the headaches often associated with?

Answer 3

Autonomic symptoms

Red, swollen and watering eye
Pupil constriction (miosis)
Eyelid drooping (ptosis)
Nasal discharge
Facial sweating

Question 4

Acute management

Answer 4

Triptans (e.g. sumatriptan 6mg injected subcutaneously at the start of the headache)

High flow 100% oxygen for 15-20 minutes (can be given at home) - another option

Question 5

Prophylaxis options

Answer 5

Verapamil

Lithium

Prednisolone (a short course for 2-3 weeks to break the cycle during clusters)