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Cluster headaches

Epidemiology & Definition
  • Cluster headaches are one of the most painful types of headache.
  • More common in men than women, often starting between ages 20 and 40.
Clinical Presentation
  • Characterised by recurrent, severe, unilateral (around the eye) headache attacks.
  • Episodes typically last between 15 minutes and 3 hours.
  • Associated symptoms include:
    • Conjunctival injection (redness).
    • Nasal congestion or rhinorrhoea.
    • Forehead and facial sweating.
    • Miosis (pupil constriction) or ptosis (drooping eyelid).
    • Restlessness or agitation.
  • Attack frequency can range from one every other day to up to eight times per day.
  • Typically, episodes occur in clusters or bouts lasting several weeks or months, separated by remission periods.
Aetiology & Pathophysiology
  • Exact cause is unclear but may be related to abnormalities in the hypothalamus.
  • Triggers can include alcohol, strong smells, and changes in sleep pattern.
Investigations
  • Diagnosis is largely clinical based on characteristic symptoms.
  • Neuroimaging (MRI) may be done to rule out other causes if presentation is atypical.
Management
  • Acute attacks: High-flow oxygen and sumatriptan injections or nasal spray.
  • Prevention: Verapamil is the mainstay of prophylaxis. Other options include lithium and corticosteroids.
Prognosis
  • Condition is chronic with acute episodic bouts. However, pain-free intervals can last months to years.

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