Headaches that occur in periods or clusters and are characterized by recurrent episodes of unilateral, intense head pain.
- Affects .4 – 2.4 persons per 1000 in the general population.
- More common in men than women (6:1).
- Usually begins in 3rd to 6th decade decades of life.
- Chronic symptoms without remission occurs in 10% of cases
PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS
- Recurrent episodes of uilateral, orbital, supraorbital, or temporal headache accompanied by ipsilateral autonomic signs.
- Attacks last 15 minutes – 3 hours occurring every other day or as frequent as 8 times a day.
- Occur in clusters or periods of frequent headaches that lasts weeks to months and are separated by periods of months to years of headache free periods.
- Headaches may be triggered by nitrates or alcohol.
- Cause is not defined but is thought to develop from events that activate the trigeminovascular system.
PERTINENT PHYSICAL EXAM FINDINGS
- Conjunctival injection
- Nasal congestion
- Eyelid edema
- Facial swelling.
- Horner’s syndrome
- Dental Abcess
- Tic douloureux
- Routine studies are of no value after diagnosis is established through history and physical.
- Acute attacks: Oxygen inhalation (100%), 8 L/minute for 15 minutes through face mask; response within 10 minutes.
- Ergotamine tartrate: sublingually for acute attack and as prophylaxis.
- Intranasal dihydroergotamine: reduces severity but not duration.
- Subcutaneous sumatriptan, 6 mg
- Lithium, verapamil , methysergide, and prednisone can also be used
PATIENT EDUCATION/ MAINTENANCE – PREVENTION
- Eliminate possible triggers such as alcohol, nitrates, vasodilator drugs.
Dr. Zachary Lahlou