Cluster headache
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
- At least 5 attacks of HA fulfilling the following criteria:
- 1. Severe unilateral orbital, supraorbital, or temporal pain lasting 15–180 min if untreated
- 2. HA is accompanied by at least one of the following:
- 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
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
- Mild traumatic brain injury
- 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
Treatment
- High-flow O2 (effective in 70% of pts)
- DHE
- Sumatriptan
Disposition
- Normally outpatient
See Also
Source
- Tintinalli
- International Headache Society Diagnostic Criteria