Cluster Headache

Cluster Headache

Clinical Features:

1. Recurrent episodes of severe unilateral headache, around the eye & temples (trigeminal distribution)
2. Sudden onset, very very severe headache
3. Accompanied by same side lacrimation, eye redness & swelling, nasal congestion, runny nose & Horner’s syndrome (ptosis + meiosis + anhidrosis) (may be cause due pancoast tumor + Horner’s syndrome)
4. Each episode lasts for few minutes to hours
5. Attacks occur daily for few weeks, then stop, then recur after a variable period (clusters)
6. No aura
7. Occur at the same time each year (e.g., spring, winter)

Triggering Factors:

Many of them same as migraine

Etiology:

Unknown

Where is the problem?:

Hypothalamus, which somehow affects the trigeminal nerve

Diagnosis:

Based on symptoms

Differential Diagnosis:

Migraine, Trigeminal neuralgia, Temporal arteritis

Treatment

A) Acute Attack:

• 100% O2 at high flow rate (15L/min) for about 20 min
• Triptans (intranasal or subcutaneous sumatriptan). Oral tabs not very effective)

B) Maintenance Prophylactic Treatment (if attacks are frequent)

• Verapamil (first choice) (migraine) CCBsX
• Lithium tablets

Rapid Fire Questions on Cluster Headache

1. Location of cluster headache? around the eye
2. Where is the pathology? hypothalamus
3. Clinical features? Congestion, swelling, tearing
4. What is Horner’s syndrome? Ptosis, Myosis, Anhidrosis
5. Any triggers? same
6. Acute treatment? O2 100% 15L
7. Chronic treatment? Verapmil, Lithum tablets
8. Differential diagnosis? Temporal Artiritis, Migraine, trigeminal neuralgia
9. Any aura? no aura