Cluster headache: Difference between revisions
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#Attacks have a frequency from one every other day to eight per day | #Attacks have a frequency from one every other day to eight per day | ||
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==Differential Diagnosis== | |||
{{Headache DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
*Based on H&P with ruled out other causes | *Based on H&P with ruled out other causes | ||
*CT when indicated to rule out other causes (mass, bleed, etc) | *CT when indicated to rule out other causes (mass, bleed, etc) | ||
==Treatment== | ==Treatment== | ||
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*International Headache Society Diagnostic Criteria | *International Headache Society Diagnostic Criteria | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 02:14, 17 September 2015
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:
- 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
Diagnosis
- Based on H&P with ruled out other causes
- CT when indicated to rule out other causes (mass, bleed, etc)
Treatment
- High-flow O2 (effective in 70% of pts)[1]
- DHE
- Sumatriptan
- Intranasal zolmitriptan
- Subcutaneous or IM dihydroergotamine and intranasal sumatriptan are additional options
Disposition
- Normally outpatient
See Also
Source
- ↑ Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14. Cluster headache: conventional pharmacological management. Becker WJ1.
- International Headache Society Diagnostic Criteria