Cluster headache
Background
- M:F = 3:1, Early adulthood.
- Cause unknown, may be familial.
Clinical
- Unilateral headache onset on waking or early hours.
- Sudden onset / offset, excruciating darting pain.
- Short-lasting headaches (10 min - 2 hours).
- No aura or neurological symptoms.
- Nausea/vomiting are rare.
- Accompanied by facial parasympathetic dysfunction.
- Ipsilateral lacrimation / rhinorrhoea
- Swollen eyelid/nose /face ± conjunctival injection.
- Partial Horner's synd. may persist after the headache.
Investigations
- If MRI required (atypical presentation or persisting autonomic features), please ensure vasculature is also imaged (MRA MRV).
Management
- High flow Oxygen (admit CDU - non-rebreather mask).
- ± subcutaneous/nasal tryptan.
- Do NOT offer paracetamol, NSAIDS, opioids or oral triptans for the acute treatment of cluster headache.
Content By Dr Íomhar O' Sullivan date. Last review Dr ÍOS 16/09/19.