CLUSTER HEADACHE

Cluster headaches are more common in middle aged men, with a ratio of 2:1
In women, it is usually seen earlier in life (in their 20s)

ASSOCIATED WITH
1. Depression
2. Asthma
3. History of migraines
4. Sleep apnea

CLINICAL PRESENTATION
The diagnosis is clinical
1. Unilateral, recurrent periorbital pain that lasts from 15 min upto 3 hours
2. Usually at night time
3. Ipsilateral injection, lacrimation and nasal congestion
4. Neurological exam is normal

PATHOPHYSIOLOGY
Posterior hypothalamus activation > increased parasympathetic outflow
The lacrimation, redness and congestion is due to parasympathetic hyperactivity
The ptosis and miosis is due to sympathetic hypoactivity

CONSIDER CT / MRI
If new onset headache after 30yrs of age

TREATMENT
Acute Attacks: O2, Triptans, Ergotamines, Butorphanol
Oxygen: 100% at 7-12 L/min for 15mins via non rebreather mask // avoid in patients with COPD

PROPHYLAXIS
Avoid triggers (alcohol, stress, medication; nitroglycerine, sildenafil)
Improve better sleep habits
Risk factor; smoking
Prednisone burst and taper
Medication: Ergotamine, Valproic acid, Calcium channel blockers, Lithium
Melatonin: 10mg daily in late evenings

AUTHORS
1. Waiz Wasey MD (Family Medicine & Sleep Medicine) – 12/8/18
Medical School: Shadan Institute of Medical Sciences
Residency: Southern Illinois School of Medicine (Springfield, IL USA)
Fellowship: Mayo Clinic (Jacksonville, FL USA)