Cluster headache
Background
- M:F = 3:1, Early adulthood
- Cause unknown, may be familial
- Rarely presents 1st episode (consider SAH) as must >5 episodes to Dx (see below)
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 ppt or persisting autonomic features), please ensure vasculature is also imaged (MRA MRV)
Management
- High flow Oxygen (admit CDU - non-rebreather mask)
- ± subcutaneous/nasal triptan
- Do NOT offer paracetamol, NSAIDS, opioids for the acute treatment of cluster headache
- Consider high dose (100mg prednisolone) steroids (only acutely) in persistent cases
- Prophylaxis: consider verapamil (min. daily dose 240mg)
- Neurologist (not EM) may consider prophylactic lithium, topiramate or galcanezumab
Content by Dr Íomhar O' Sullivan . Last review Dr ÍOS 2/11/23.