Cluster Headache.

Headaches that occur in periods or clusters and are characterized by recurrent episodes of unilateral, intense head pain.

 ETIOLOGY/ PATHOGENESIS

  • 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
  • Lacrimation
  • Rhinorrhea
  • Nasal congestion
  • Ptosis
  • Miosis
  • Eyelid edema
  • Facial swelling.
  • Horner’s syndrome

 DIFFERENTIAL DIAGNOSIS

  • Sinusitis
  • Dental Abcess
  • Tic douloureux

 DIAGNOSTIC EVALUATIONS

  • Routine studies are of no value after diagnosis is established through history and physical.

 MEDICAL MANAGEMENT

  • 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.

images (1)  Gray778

Dr. Zachary Lahlou

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