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Cluster Headache (Migrainous Neuralgia)

Last updated 25.08.13

 

Index

 

Definition

-      Rare severe unilateral headache

 

Features

-      Incidence 70:100,000

-     Less common than migraine

-      Men 5:1 women

-      Typical onset 20-40yrs of age

-      Two main forms

-     Episodic: alternative between attacks & remissions

-     Chronic lacking remissions: 1yr of pain without remission

 

Associated S/S

-      Unilateral Headache

-     Excruciating, boring, burning pain localised around one eye

-     May radiate to forehead, temple, cheek, or upper gum on same side of face

-     Constant pain

-     Typically sudden onset, without warning & reaches maximum intensity within 2-15min

-     Attacks last 15-180 minutes (mean 45 min)

-     1-3 attacks per day

-     Attacks can occur on consecutive days for 6-8 weeks

-     Remissions for months to years

-     Always unilateral & usually effects same side each time

-    Other symptoms may be bilateral

-      Ptosis

-      Eye lacrimation

-      Conjunctival injection

-      Rhinorrhoea or nasal obstruction on same side as headache

-      Nausea

+/- Horners syndrome

-      Triggers

-     EtOH

-     GTN

-     Histamine

-     COC

-    May cease during pregnancy

 

Risk Factors

-      Smoking

-      Family Hx

 

Cause

-      ?related hypothalamic function

 

Ix

-      Neuro exam

-      +/- CT/MRI to exlude other pathology

 

Mx

-      Quit smoking

-      Avoid EtOH during attakcs

-      Regular sleep pattern

-      Avoid high stress or strenuous physical activity

-      Oxygen

-     100% O2 via mask at 12L+/min

-     Effective within 15minutes

-      Analgesia

-     Sumitriptan injection

-     Zolmitriptan nasal spray or PO

-     Egotamine aerosol 0.36-1.08mg 1-3 puffs for acute attack

-    Prevention

-     CCB

-    Verapamil

-    Nifedipine 40-120mg Daily

-     Corticosteroids

-    Prednisolone

-     Lithium

-     Occipital nerve block

-     Egotamine 2mg PO TDS for prophylaxis

-     Topiramate

-     Trigeminal nerve resection

 

 

 

References

 

Headache Australia: Cluster Headache, headacheaustralia.org.au/headache-types/18-cluster-headache-rare-and-extremely-painful