Cluster headache: Difference between revisions
 
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*Occur most often in middle aged men
*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.   
*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>===
===Definition<ref>International Headache Society Diagnostic Criteria</ref>===
''At least 5 attacks of headache fulfilling the following criteria:''
''At least 5 attacks of headache fulfilling the following criteria:''
*Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
#Severe '''unilateral''' orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
*Headache accompanied by at least one of the following:
#[[Headache]] accompanied by at least one of the following:
**Ipsilateral conjunctival injection and/or lacrimation
#*Ipsilateral conjunctival injection and/or lacrimation
**Ipsilateral nasal congestion and/or rhinorrhea
#*Ipsilateral nasal congestion and/or rhinorrhea
**Ipsilateral eyelid edema
#*Ipsilateral eyelid edema
**Ipsilateral forehead and facial sweating
#*Ipsilateral forehead and facial sweating
**Ipsilateral miosis and/or ptosis
#*Ipsilateral miosis and/or ptosis
**A sense of restlessness or agitation
#*A sense of restlessness or agitation
*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
*Not attributed to another disorder
#Not attributed to another disorder


==Differential Diagnosis==
==Differential Diagnosis==
{{Headache DDX}}
{{Headache DDX}}


==Diagnosis==
==Evaluation==
*Based on H&P with ruled out other causes
*Consider other emergent causes of [[headache]] based on H&P
*CT when indicated to rule out other causes (mass, bleed, etc)
**Consider [[head CT|CT]], [[LP]], and/or eye pathology
*Typically a clinical diagnosis


==Treatment==
==Management==
*High-flow O2 (effective in 70% of pts)<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>
*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%
*DHE
*DHE
*Sumatriptan
*[[Sumatriptan]]
*Intranasal zolmitriptan
*Intranasal zolmitriptan
*Subcutaneous or IM dihydroergotamine and intranasal sumatriptan are additional options
*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==
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<references/>
<references/>


[[Category:Neuro]]
[[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:

  1. Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
  2. 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
  3. Attacks have a frequency from one every other day to eight per day
  4. Not attributed to another disorder

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Evaluation

  • Consider other emergent causes of headache based on H&P
    • Consider CT, LP, and/or eye pathology
  • 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

  1. ↑ International Headache Society Diagnostic Criteria
  2. ↑ Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14. Cluster headache: conventional pharmacological management. Becker WJ1.
  3. ↑ 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
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