Cluster headache
Cluster headaches* are more common in men (5:1) and smokers.
Features
Management
*some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). It is recommended such patients are referred for specialist assessment as specific treatment may be required, for example it is known paroxysmal hemicrania responds very well to indomethacin
Features
- pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
- clusters typically last 4-12 weeks
- intense pain around one eye (recurrent attacks 'always' affect same side)
- patient is restless during an attack
- accompanied by redness, lacrimation, lid swelling
- nasal stuffiness
- miosis and ptosis in a minority
Management
- acute: 100% oxygen, subcutaneous or a nasal triptan
- prophylaxis: verapamil, prednisolone
- NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging
*some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). It is recommended such patients are referred for specialist assessment as specific treatment may be required, for example it is known paroxysmal hemicrania responds very well to indomethacin
