Cluster Headache

Background/Epidemiology

  • Much less common than migraine (55-70/100000)
  • 5:1 male predominance; onset usually in 30s

Pathophysiology

  • Cause unknown but (compared to migraine)- lacks genetic predisposition, provoking dietary factors etc
  • More common in smokers and patients with alcohol excess (these can be triggers)
  • Excess abnormal hypothalamic activity has been implicated

Clinical Features

  • Strictly periodic runs of identical headaches beginning at the same time of day for weeks at a time (cluster).  Between clusters, the patient is usually normal and may not relapse for months-years.
    • Can have more than one attack per day
    • Usually characterised by brief (30-90 minutes) episodes of severe, unilateral periorbital pain with autonomic features e.g.
      • lacrimation (tearing)
      • nasal congestion
      • conjunctival injection
    • The patient is often agitated during headaches

Management

  • Acute attacks can be treated by subcut sumatriptan and/or oxygen treatment
  • Steroids (short-term/low-dose) and verapamil can be used in patients who suffer frequent clusters for prophylaxis
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