Cluster headache

Question 1

What is the prevalence of cluster headaches?

Answer 1

1 in 1000

Question 2

Which sex do cluster headaches more commonly present in?

Answer 2

male

Question 3

When is the peak age of onset for cluster headache?

Answer 3

20-40 y/o

Question 4

What are episodic cluster headaches?

Answer 4

cluster headaches that occur in periods lasting from 7 days to a year separated by pain-free periods of a least a month (cluster periods usually last between 2 weeks and 3 months)

Question 5

What are chronic cluster headaches?

Answer 5

cluster headaches that last for one year with no remissions

Question 6

What are the symptoms of cluster headaches?

Answer 6

• rapid onset of excruciating pain around one eye (no aura)
• eye may become swollen, watery, bloodshot, lacrimation,
• facial flushing
• rhinorrhoea (runny nose)
• pain is strictly unilateral
• lasts 15-180 minutes
• occurs once or twice daily (often nocturnal)
• mitosis+/- ptosis (pupil constriction +/- eyelid drooping)

Question 7

What are triggers for cluster headaches?

Answer 7

Alcohol(potent trigger)
histamines
nitroglycerine
heat
exercise
solvents
disruptions to sleep patterns

Question 8

What is the diagnostic criteria for cluster headaches?

Answer 8

At least 5 headaches fulfilling the following criteria:

• severe or very severe unilateral, orbital, supraorbital +/- temporal pain lasting 15-180 minutes if untreated
• headache accompanied by ipsilateral cranial autonomic features +/- restlessness/agitation
• attacks have frequency from 1 every other day to 8 a day
• not attributed to another disorder

Question 9

What are red flags to search for secondary cause or cluster headache?

Answer 9

• change in headache pattern
• new headache onset > 50
• onset of seizures
• headache with systemic illness
• personality change
• symptoms characteristic of increased ICP
• acute onset of worst headache ever

Question 10

what is the management of an acute attack of cluster headaches?

Answer 10

100% O2 for around 15 minutes via a non-rebreathe mask

SC sumatriptan - 6mg at onset

Question 11

What are preventative medicines for cluster headache?

Answer 11

suboccipital steroid injections
verapamil (CCB)
lithium
melatonin