Cluster Headaches

Question 1

Define cluster headache

Answer 1

Most disabling primary headache, most common trigeminal autonomic cephalagia

Question 2

What are the risk factors for cluster?

Answer 2

Male 5x more likely
Smoking
Head injury
Family history

Question 3

What is the aetiology for clusters?

Answer 3

Unknown
Thought to be result of hypothalamic activation with secondary trigeminal and autonomic activation.
Triggers - alcohol, strong smells, sleep, weather, circadian disruption

Question 4

What are the signs and symptoms of a cluster?

Answer 4

Rapid onset, excruciating pain around one eye (watery, bloodshot, lid swelling) , rhinorrhea.
Pain unilateral lasting from 15-180 minutes.
Can happen from once every other day to 8 times a day.

Question 5

How long do clusters last?

Answer 5

4 -12 weeks

Can be episodic with a long grace period, more common than chronic

Question 6

Does pain present on same side usually?

Answer 6

Yes

Question 7

How can you treat an acute attack?

Answer 7

Oxygen and sumatriptans

Question 8

How can you investigate clusters?

Answer 8

MRI without contrast - to rule out secondary causes
Otherwise a clinical diagnosis.
ESR to rule out GCA in over 50s.

Question 9

What are some secondary causes of clusters?

Answer 9

Vascular (internal carotid artery dissection) , tumors (above pituitary/suprasellar), inflammatory.
Cerebral venous thromobsis.
Contralateral structural pathologies can trigger.