Cluster headache

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.

Definition

• At least 5 attacks of headache fulfilling the following criteria:

1. Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
2. Headache accompanied by at least one of the following:
   1. Ipsilateral conjunctival injection and/or lacrimation
   2. Ipsilateral nasal congestion and/or rhinorrhea
   3. Ipsilateral eyelid edema
   4. Ipsilateral forehead and facial sweating
   5. Ipsilateral miosis and/or ptosis
   6. A sense of restlessness or agitation
3. Attacks have a frequency from one every other day to eight per day
4. Not attributed to another disorder

Diagnosis

• Based on H&P with ruled out other causes

Work-Up

• Neurological Exam
• CT when indicated to rule out other causes (mass, bleed, etc)

Differential Diagnosis

Headache

Common

• Migraine headache
• Tension headache
• Cluster headache

Killers

• Meningitis/encephalitis
  • Neoplastic meningitis
• 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
  • Varicella
  • Herpes
  • Enterovirus
  • West Nile
• Tuberculosis
• Lyme disease
• Syphilis
• Leptospirosis
• Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
• Noninfectious
  • Sarcoidosis
  • Vasculitis
  • Connective tissue disease
  • Drug induced aseptic meningitis

Treatment

• High-flow O2 (effective in 70% of pts)
• DHE
• Sumatriptan

Disposition

• Normally outpatient

See Also

• Headache
• Migraine Headache
• Tension Headache

Source

• Tintinalli
• International Headache Society Diagnostic Criteria