Cluster headache: Difference between revisions
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==Management== | ==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> | *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% | *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 | ||
Revision as of 00:03, 11 September 2016
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[1]
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
- 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
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