Cluster Headaches

Question 1

Definition of a cluster headache

Answer 1

Neurological disorder characterised by recurrent, severe headaches on one side of head typically around the eye normally occurring over several weeks

Question 2

What is the aietiology/ risk factors of cluster headaches?

Answer 2

• Unknown aietiology

- A genetic factor is implicated

Question 3

Epidemiology of cluster headaches

Answer 3

• More common in men

- Usually in people aged between 20-40 years old

Question 4

What are the two types of cluster headaches?

Answer 4

• Episodic - Occurs in periods lasting 1 week - 1 year which are seperated by pain-free periods which last a month or longer. Cluster periods usually last between 2 weeks and 3 months
• Chronic - Occurs for 1 year without remission or w/ short-lived remissions of less than a month. Chronic cluster headaches can arise de novo or arise from episodic cluster headaches

Question 5

Describe the pattern of occurrance in cluster headaches.

Answer 5

• Headaches occurring in bouts lasting 6-12 weeks
• These occur once a year, once every 2 years and tend to occur at the same time each year
• Headaches typically occur at night, 1-2 hours after falling asleep
• The interval between bouts tends to be the same
• 10% with episodic cluster headaches go on to develop chronic cluster headaches

Question 6

Describe the nature of symptoms that occur in cluster headaches.

Answer 6

• Pain comes on rapidly over around 10 mins
• Pain is intense, sharp and penetrating
• Pain is centred around the eye, temple or forehead
• Pain is unilateral
• Pain typically lasts around 45-90 mins (range: 15 mins - 3 hours)
• Pain occurs once or twice daily
• Associated autonomic features: Ipsilateral lacrimation, Rhinorrhoea, Nasal congestion, Eye lid swelling, Facial swelling, Flushing, Conjunctival injection and Partial Horner’s syndrome
• Patients find it difficult to stay still and will pace around, occasionally banging their heads on things

Question 7

What can trigger cluster headaches?

Answer 7

• ALCOHOL - major precipitant
• Exercise and solvents
• Sleep disruption

Question 8

Investigations for cluster headaches

Answer 8

CLINICAL diagnosis based on history

Neurological examination may be useful