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
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{{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
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<references/>
<references/>


[[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.