Cluster headache: Difference between revisions

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==Definition==
==Background==
*At least 5 attacks of HA fulfilling the following criteria:
*Occur most often in middle aged men
**1. Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
*Classically occur in "clusters" over days to weeks typically  at the same time of day and same anatomical location.
**2. HA is accompanied by at least one of the following:
*Triggers may be alcohol, nitroglycerin, histamine
***a. Ipsilateral conjunctival injection and/or lacrimation
***b. Ipsilateral nasal congestion and/or rhinorrhea
***c. Ipsilateral eyelid edema
***d. Ipsilateral forehead and facial sweating
***e. Ipsilateral miosis and/or ptosis
***f. 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==
 
 
==Work-Up==


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


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


==Disposition==
==Disposition==
*Normally outpatient


==See Also==
==See Also==
*[[Headache]]
*[[Headache]]
*[[Migraine Headache]]
*[[Tension Headache]]


==Source==
==References==
*Tintinalli
<references/>
*International Headache Society Diagnostic Criteria
 
[[Category:Neuro]]
[[Category:Neurology]]

Revision as of 00:25, 3 October 2019

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

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.