Condition- cluster headaches

Question 1

What are cluster headaches?

Answer 1

A neurological disorder causing acute recurrent unilateral headaches normally around one eye. They have aan annual recuring pattern over a period of several weeks.

Thought to be one of the most painful conditions!!

Question 2

List the three cardinal features of cluster headaches

Answer 2

1. Trigeminal distribution of the pain
2. Ipsilateral cranial autonomic symptoms
3. Circadian/circannual pattern of attacks

Question 3

List some of the theorised causes of cluster headaches

Answer 3

UNKNOWN Aetiology but is associated with:

• Superficial temporal artery smooth muscle hyperreactivity to 5-HT
• Grey matter abnormalities
• Autosominal dominant gene may have a role

Question 4

List some of the risk factors associated with cluster headaches

Answer 4

• Alcohol
• Strong smells
• Sleep distrubance/ apneoa
• FHx

But non of these have a significant causal relationship

Question 5

Describe the epidemiology of cluster headaches (gender and age)

Answer 5

• Most common in males (5:1 ratio)
• Occurs between 20-40 years

Question 6

Descibe the timing of cluster headache episodes

Answer 6

ACUTE RECURRENT

• Episodes last 15mins - 3hrs
• Can have multiple episodes a day
• Episodes recur for 4-12 weeks
• Then they disappear but come back a year or so later

Question 7

What is the difference between chronic and episodic cluster headaches?

Answer 7

• EPISODIC: At least 2 cluster periods lasting 7 to 365 days and separated by pain-free remission periods lasting at least 1 month
• CHRONIC: Attacks occur over more than 1 year without remission periods or with remission periods lasting less than 1 month.

Question 8

Describe the pain associated with cluster headaches

Answer 8

• S: Pain centred around eye, temple or forehead + unilateral
• O: sudden onset
• C: Intense, sharp, piercing pain (not dull)
• R: X- unilateral side may swap
• A: autonomic symptoms
• T: Pain lasts 15mins - 3hrs. Mutliple daily + cyclical timing
• E: alcohol, sleep, volatile smells, temp
• S: sever- considered one of the most painful conditions

SO PAINFUL THAT PTS DISTRACT THEMSELVES BY BANGING HEAD ETC.

Question 9

Apart from pain, people suffereing from Cluster headaches suffer from a group of other associated symptoms- what are they and list some examples

Answer 9

AUTONOMIC SYMTPTOMS: (Thought to be caused by trigeminal nerve activation)

• EYES:
  
  • Blood shot eye
  • Ipsilateral lacrimation
  • Lid oedema (ptosis)
  • Miosis = partial Horner’s
  • Conjuctival infection
• NOSE:
  
  • Rhinorrhoea
  • Nasal Congestion
• FACE:
  
  • Flushing
  • Facial swelling

Question 10

Which investigations could you order to diagnose someone with cluster headaches?

Answer 10

Purely CLINICAL diagnosis based on history

Could do neurological examination (to asses autonomic symptoms)