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**'''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>
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{{familytree/end}}<ref name="urlManaging cluster headache | Practical Neurology">{{cite web |url=http://dx.doi.org/10.1136/practneurol-2018-002124 |title=Managing cluster headache &#124; Practical Neurology |format= |work= |accessdate=}}</ref>

Revision as of 17:11, 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]

Migraine Cluster Headache
Typical patient Young woman Young man
Triggered by alcohol No Yes
Periodicity No Yes
Aura Yes (with classic form) No
Autonomic symptoms No Yes
Response to O2 No Yes

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]
 
 
 
 
 
 
 
 
Cluster Headache Acute treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sumatriptan subcutaneous injection
 
Zolmitriptan nasal spray
 
Sumatriptan nasal spray
 
Oxygen
 
non invasive vagus nerve stimulator

[7]

  1. . doi:10.1036/007149913X. Missing or empty |title= (help)
  2. . doi:10.1036/007149913X. Missing or empty |title= (help)
  3. . doi:10.1036/007149913X. Missing or empty |title= (help)
  4. . doi:10.1036/007149913X. Missing or empty |title= (help)
  5. . doi:10.1036/007149913X. Missing or empty |title= (help)
  6. . doi:10.1036/007149913X. Missing or empty |title= (help)
  7. "Managing cluster headache | Practical Neurology".