Cluster headache: Difference between revisions
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== | ==Background== | ||
* | *Occur most often in middle aged men | ||
* | *Classically occur in "clusters" over days to weeks typically at the same time of day and same anatomical location. | ||
*Triggers may be alcohol, nitroglycerin, histamine | |||
* | |||
== | ===Definition<ref>International Headache Society Diagnostic Criteria</ref>=== | ||
''At least 5 attacks of headache fulfilling the following criteria:'' | |||
#Severe '''unilateral''' orbital, supraorbital, or temporal pain lasting 15–180 min if untreated | |||
#[[Headache]] accompanied by at least one of the following: | |||
#*Ipsilateral conjunctival injection and/or lacrimation | |||
#*Ipsilateral nasal congestion and/or rhinorrhea | |||
#*Ipsilateral eyelid edema | |||
#*Ipsilateral forehead and facial sweating | |||
#*Ipsilateral miosis and/or ptosis | |||
#*A sense of restlessness or agitation | |||
#Attacks have a frequency from one every other day to eight per day | |||
#Not attributed to another disorder | |||
==Differential Diagnosis== | |||
{{Headache DDX}} | |||
== | ==Evaluation== | ||
*Consider other emergent causes of [[headache]] based on H&P | |||
**Consider [[head CT|CT]], [[LP]], and/or eye pathology | |||
*Typically a clinical diagnosis | |||
==Management== | |||
== | *High-flow [[O2]] (effective in 70% of patients)<ref>Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14. Cluster headache: conventional pharmacological management. Becker WJ1.</ref> | ||
*Intranasal [[lidocaine]] 4% | |||
*High-flow O2 (effective in 70% of | |||
*DHE | *DHE | ||
*Sumatriptan | *[[Sumatriptan]] | ||
*Intranasal zolmitriptan | |||
*Subcutaneous or IM dihydroergotamine and intranasal sumatriptan are additional options | |||
*[[Verapamil]] can be used for prophylaxis | |||
*[[Prednisone]] taper with [[verapamil]] has shown to reduce frequency of attacks<ref>Obermann M, Nägel S, Ose C, et al. Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol. 2021;20(1):29-37. doi:10.1016/S1474-4422(20)30363-X</ref> | |||
==Disposition== | ==Disposition== | ||
*Normally outpatient | |||
==See Also== | ==See Also== | ||
*[[Headache]] | *[[Headache]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Neurology]] | ||
Latest revision as of 22:11, 12 January 2021
Background
- Occur most often in middle aged men
- Classically occur in "clusters" over days to weeks typically at the same time of day and same anatomical location.
- Triggers may be alcohol, nitroglycerin, histamine
Definition[1]
At least 5 attacks of headache fulfilling the following criteria:
- Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
- Headache accompanied by at least one of the following:
- Ipsilateral conjunctival injection and/or lacrimation
- Ipsilateral nasal congestion and/or rhinorrhea
- Ipsilateral eyelid edema
- Ipsilateral forehead and facial sweating
- Ipsilateral miosis and/or ptosis
- A sense of restlessness or agitation
- Attacks have a frequency from one every other day to eight per day
- Not attributed to another disorder
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
- Consider other emergent causes of headache based on H&P
- Typically a clinical diagnosis
Management
- High-flow O2 (effective in 70% of patients)[2]
- Intranasal lidocaine 4%
- DHE
- Sumatriptan
- Intranasal zolmitriptan
- Subcutaneous or IM dihydroergotamine and intranasal sumatriptan are additional options
- Verapamil can be used for prophylaxis
- Prednisone taper with verapamil has shown to reduce frequency of attacks[3]
Disposition
- Normally outpatient
See Also
References
- ↑ International Headache Society Diagnostic Criteria
- ↑ Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14. Cluster headache: conventional pharmacological management. Becker WJ1.
- ↑ Obermann M, Nägel S, Ose C, et al. Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol. 2021;20(1):29-37. doi:10.1016/S1474-4422(20)30363-X