User:JaspinderKaur

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jaspinder Kaur, MBBS[2]

Cluster Headache

Synonyms and keywords: Ciliary Neuralgia; neuralgic migraine; histamine cephalgia; horton syndrome; chronic cluster headache; episodic cluster headache; atypical cluster headache; vasogenic facial pain

Overview

Cluster headache is a rare disorder typically associated with the excruciating, unilateral and periorbital painful episodes lasting for few minutes to hours. It might be accompanied with facial autonomic symptoms, restlessness and migraine like aura symptoms in approximately 23% of patients. It classically occur in young men 20–40 years of age with the male-to-female ratio of 5:1. . A family history of similar headaches is uncommon.

Clinical Symptoms

• The cardinal feature is periodicity. Headaches occur many times daily at distinct times over several weeks; onset with sleep is especially characteristic.
• Clusters spontaneously remit for months to years before recurring, typically at the same time of year as previous attacks. Alcohol is a classic trigger.
• Cluster headaches do not have auras (vs. migraines). A typical attack is characterized by abrupt-onset, severe unilateral periorbital pain with associated ipsilateral autonomic symptoms (tearing of the eye and nares; rarely Horner’s). Headaches typically last 30–120 minutes.

Physical Examination

• Patients are restless and agitated, often pacing the room (vs. migraine patients).
• Look for tearing, nasal discharge, and/or ptosis (e.g., Horner’s) ipsilateral to the location of eye pain.

Differential Diagnosis

Other headache syndromes, including migraine and chronic paroxysmal hemicrania, which has similar symptoms, but with multiple (20–40) daily attacks lasting 5–10 minutes each and no periodicity (exquisitely sensitive to indomethacin).

	Migraine	Cluster Headache
Typical patient	Young woman	Young man
Triggered by alcohol	No	Yes
Periodicity	No	Yes
Aura	Yes (with classic form)	No
Autonomic symptoms	No	Yes
Response to O2	No	Yes

Treatment

• Prophylactic therapy
  • It is started once cluster headaches begin but are not used during remissions given that months to years may elapse between clusters. Such medications include verapamil (first-line prophylactic treatment for cluster headache), prednisone (a taper of oral steroids is often used at the beginning of a cluster), lithium, valproate, and methysergide.

• Abortive therapy
  • O2 inhalation: Give 5–10 L/min for 10–15 minutes.
  • Intranasal lidocaine ointment: Produces a block of the sphenopalatine ganglion and aborts the headache.
  • Triptans: Also useful for acute attacks.

Cluster Headache Acute treatment

Sumatriptan subcutaneous injection

Zolmitriptan nasal spray

Sumatriptan nasal spray

Oxygen

non invasive vagus nerve stimulator