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===Overview=== | ===Overview=== | ||
Cluster headache is a rare disorder typically associated with the excruciating, unilateral and periorbital painful episodes lasting for few minutes to hours. It might be accompanied with facial autonomic symptoms, restlessness and migraine like aura symptoms in approximately 23% of patients. It classically occur in '''young men''' 20–40 years of age with the male-to-female ratio of 5:1. <ref>{{cite journal|doi=10.1036/007149913X}}</ref>. A family history of similar headaches is uncommon. | ''Cluster headache'' is a rare disorder typically associated with the excruciating, unilateral and periorbital painful episodes lasting for few minutes to hours. It might be accompanied with facial autonomic symptoms, restlessness and migraine like aura symptoms in approximately 23% of patients. It classically occur in '''young men''' 20–40 years of age with the male-to-female ratio of 5:1. <ref>{{cite journal|doi=10.1036/007149913X}}</ref>. A family history of similar headaches is uncommon. | ||
===Clinical Symptoms=== | ===Clinical Symptoms=== | ||
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*The cardinal feature is '''periodicity'''. Headaches occur '''many times daily''' at '''distinct times''' over several weeks; onset with sleep is especially characteristic. | *The cardinal feature is '''periodicity'''. Headaches occur '''many times daily''' at '''distinct times''' over several weeks; onset with sleep is especially characteristic. | ||
*Clusters spontaneously remit for months to years before recurring, typically at the same time of year as previous attacks. '''Alcohol''' is a classic trigger. | *Clusters spontaneously remit for months to years before recurring, typically at the same time of year as previous attacks. '''Alcohol''' is a classic trigger. | ||
*Cluster headaches do not have auras (vs. migraines). A typical attack is characterized by abrupt-onset, severe '''unilateral periorbital pain''' with associated '''ipsilateral autonomic symptoms''' (tearing of the eye and nares; rarely Horner’s). Headaches typically last 30–120 minutes.<ref>{{cite journal|doi=10.1036/007149913X}}</ref> | *''Cluster headaches'' do not have auras (vs. migraines). A typical attack is characterized by abrupt-onset, severe '''unilateral periorbital pain''' with associated '''ipsilateral autonomic symptoms''' (tearing of the eye and nares; rarely Horner’s). Headaches typically last 30–120 minutes.<ref>{{cite journal|doi=10.1036/007149913X}}</ref> | ||
===Physical Examination=== | ===Physical Examination=== | ||
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===Treatment=== | ===Treatment=== | ||
*'''Prophylactic therapy''' | *'''''Prophylactic therapy''''' | ||
**It is started once cluster headaches begin but are not used during remissions given that months to years may elapse between clusters. Such medications include '''verapamil''' (first-line prophylactic treatment for cluster headache), '''prednisone''' (a taper of oral steroids is often used at the beginning of a cluster), lithium, valproate, and methysergide. <ref>{{cite journal|doi=10.1036/007149913X}}</ref> | **It is started once cluster headaches begin but are not used during remissions given that months to years may elapse between clusters. Such medications include '''verapamil''' (first-line prophylactic treatment for cluster headache), '''prednisone''' (a taper of oral steroids is often used at the beginning of a cluster), lithium, valproate, and methysergide. <ref>{{cite journal|doi=10.1036/007149913X}}</ref> | ||
*'''Abortive therapy''' | *'''''Abortive therapy''''' | ||
**'''O2 inhalation''': Give 5–10 L/min for 10–15 minutes. | **'''O2 inhalation''': Give 5–10 L/min for 10–15 minutes. | ||
**'''Intranasal lidocaine ointment''': Produces a block of the sphenopalatine ganglion and aborts the headache. | **'''Intranasal lidocaine ointment''': Produces a block of the sphenopalatine ganglion and aborts the headache. | ||
**'''Triptans''': Also useful for acute attacks.<ref>{{cite journal|doi=10.1036/007149913X}}</ref> | **'''Triptans''': Also useful for acute attacks.<ref>{{cite journal|doi=10.1036/007149913X}}</ref> | ||
Revision as of 14:05, 10 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Jaspinder Kaur
Cluster Headache
Synonyms and keywords: Ciliary Neuralgia; neuralgic migraine; histamine cephalgia; horton syndrome; chronic cluster headache; episodic cluster headache; atypical cluster headache; vasogenic facial pain
Overview
Cluster headache is a rare disorder typically associated with the excruciating, unilateral and periorbital painful episodes lasting for few minutes to hours. It might be accompanied with facial autonomic symptoms, restlessness and migraine like aura symptoms in approximately 23% of patients. It classically occur in young men 20–40 years of age with the male-to-female ratio of 5:1. [1]. A family history of similar headaches is uncommon.
Clinical Symptoms
- The cardinal feature is periodicity. Headaches occur many times daily at distinct times over several weeks; onset with sleep is especially characteristic.
- Clusters spontaneously remit for months to years before recurring, typically at the same time of year as previous attacks. Alcohol is a classic trigger.
- Cluster headaches do not have auras (vs. migraines). A typical attack is characterized by abrupt-onset, severe unilateral periorbital pain with associated ipsilateral autonomic symptoms (tearing of the eye and nares; rarely Horner’s). Headaches typically last 30–120 minutes.[2]
Physical Examination
- Patients are restless and agitated, often pacing the room (vs. migraine patients).
- Look for tearing, nasal discharge, and/or ptosis (e.g., Horner’s) ipsilateral to the location of eye pain.[3]
Differential Diagnosis
Other headache syndromes, including migraine and chronic paroxysmal hemicrania, which has similar symptoms, but with multiple (20–40) daily attacks lasting 5–10 minutes each and no periodicity (exquisitely sensitive to indomethacin).[4]
Treatment
- Prophylactic therapy
- It is started once cluster headaches begin but are not used during remissions given that months to years may elapse between clusters. Such medications include verapamil (first-line prophylactic treatment for cluster headache), prednisone (a taper of oral steroids is often used at the beginning of a cluster), lithium, valproate, and methysergide. [5]
- Abortive therapy
- O2 inhalation: Give 5–10 L/min for 10–15 minutes.
- Intranasal lidocaine ointment: Produces a block of the sphenopalatine ganglion and aborts the headache.
- Triptans: Also useful for acute attacks.[6]
- ↑ . doi:10.1036/007149913X. Missing or empty
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