Cluster Headache Flashcards
Definition
A neurological disorder characterised by recurrent, severe headaches on one side of the head typically around the eye, tending to recur over a period of several weeks.
Aetiology
- UNKNOWN aetiology
* Genetic factor implicated
Epidemiology
- More common in MEN
* Usually occurs between 20-40 yrs
Two types of cluster headaches
o Episodic - occurring in periods lasting 7 days - 1 year, separated by pain-free periods lasting a month or longer. Cluster periods usually last between 2 weeks - 3 months
o Chronic - occurring for 1 year without remissions or with short-lived remissions
of less than a month. Chronic cluster headaches can arise de novo or arise from episodic cluster headaches.
Pattern
o Headaches occur in bouts lasting 6-12 weeks
o These occur once every year or once every 2 years, and tends to occur at the same time each year
o Headaches typically occurs at night, 1-2 hours after falling asleep
o The interval between bouts tends to be the same
o 10% with episodic cluster headaches go on to develop chronic cluster headaches
Nature of symptoms
o Pain comes on rapidly over around 10 mins
o Pain is intense, sharp and penetrating
o Pain is centred around the eye, temple or forehead
o Pain is unilateral
o Pain typically lasts around 45-90 mins (range: 15 mins - 3 hours)
o Pain occurs once or twice daily
Patients find it difficult to stay still and will pace around, occasionally banging their heads on things
Associated symptoms
o Associated autonomic features: • Ipsilateral lacrimation • Rhinorrhoea • Nasal congestion • Eye lid swelling • Facial swelling • Flushing • Conjunctival injection • Partial Horner's syndrome
Triggers
o ALCOHOL - major precipitant
o Exercise and solvents
o Sleep disruption
Investigations
- CLINICAL diagnosis based on history
* Neurological examination may be useful
