Cluster Headache

WHAT IS IT?

Cluster headache refers to a specific type of headache that is often characterized by very severe periorbital pain that comes in a “cluster” of repetitive short lasting headaches.

Source
Source
WHAT CAUSES IT?

While the exact cause is not completely understood, this type of headache can be precipitated by:

  • Alcohol intake
  • Vasodilator drug use
WHY IS IT A PROBLEM?

This type of headache is very painful and can even disrupt the patient’s sleep regularly.

WHAT MAKES US SUSPECT IT?

Risk factors

Male sex, recent alcohol usage, recent vasodilating drug use.

Initial Presentation

Common Chief Complaints:

  • Headache 

History Of Present Illness

Nature of headache is characterized by: 

  • Onset: can wake individual up form sleep (often regularly at the same time each day)
  • Location: unilateral, often periorbital.
  • Timing: repetitive brief headaches that can last 15 min-3 hours
  • Quality: excruciating pain (can be described as “stabbing”)
  • Associated symptoms: excessive tear production and runny/stuffy nose may also be present

Physical Exam Findings

**Horner syndrome may be caused by this headache**

HEENT (during headache) can show: 

  • Ptosis
  • Miosis
  • Conjunctival injection
  • Rhinorrhea
  • Lacrimation
  • Facial swelling/flushing/sweating

Neurological exam should otherwise be unremarkable.

CLINICAL WORKUP

Clinical diagnosis is made based upon the classic findings above.

HOW DO WE TREAT IT? 

Acute therapy:

100% oxygen supplementation can often provide immediate relief

Triptans such as sumatriptan can also be used as an abortive therapy.

Prophylactic therapy:

Pharmacological options include: 

HOW WELL DO THE PATIENTS DO?

This headache generally will respond to treatment.

WAS THERE A WAY TO PREVENT IT? 

N/A

WHAT ELSE ARE WE WORRIED ABOUT?

Secondary causes of cluster headache can include:

  • Pituitary tumors
  • Carotid artery dissection
  • Cavernous sinus lesions
OTHER FACTS?

“Alarm clock headache” is used to describe a cluster headache because it can sometimes regularly awaken patients from sleep (at consistent times). It is believed to be associated with the circadian rhythm in some way due to its regularity.

Only type of headache that is more common in men than women 

FURTHER READING

DynaMed

UpToDate

 

Page Updated: 07.25.2016