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.
  • 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.