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!