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

Differential Dx


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 . Last review Dr ÍOS 15/06/21.