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Cluster Headache

Introduction

  • Episodic or chronic

  • Mostly occur in men with an onset in 20’s

  • Circadian rhythm

  • Sudden onset just after sleep; peaks in 5 mins

  • Sharp, unilateral pain around the orbit - may be very severe

  • Lacrimation, conjunctivitis, nasal congestion can occur

Assessment

  • Redness around the eye

  • Injected conjunctiva

  • Lacrimation

  • Rhinorrhoea

  • No Red Flags!

  • Constricted pupil and a drooping eyelid can occur with cluster headaches but seek senior or specialist advice with these patients.

  • Investigations - none required. If you are performing any investigations, it is because you are concerned about another type of headache and should follow that pathway.

Management

  • High flow oxygen

  • Intranasal cophenylcaine spray

  • Sumatriptan - migraine medication, may be useful if taken early

  • Refer to medical / neurological outpatients for follow-up

  • Steroids and ergotamines are used for prevention

Disposition

May require short stay admission or home when:

  • Pain manageable for patient

  • No postural drop

  • Vital signs normal

  • No Red Flags!

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