Cluster Headache

Cluster headache

  • More common in men usually in 3rd decade of life (women more commonly get it in their 60s)
  • Comes in a cluster lasting 2 weeks to 3 months
  • Patients will typically go 2 years w/o a HA  (most pts experience episodic)
  • Symptoms:  suicide headache, usually occurs at night, pain is unilateral, comes on quick w/o warning & is described as constant severe ice-pick like pain
    • Other symptoms:  tearing, nasal congestion, rhinorrhea, n/v, phonophobia, photophobia
  • Precipitating factors (only matter during the patient’s susceptible period):  alcohol, vasodilating drugs (nitrates, CCBs), inconsistent daily routine, weather
  • Acute treatment:
    • Preferred:  oxygen up to 5 times a day  (oral meds aren’t recommended)
    • Other:  Sumatriptan, erotamine tartrate
  • Prophylactic treatment:
    • used in patients with more than 2 attacks/day.
    •  Use until the patient is headache free for 2 weeks  (don’t just use for 2 weeks)******
    • Verapamil (CCB):  use at higher doses than for HTN, decreases HA frequency
    • Lithium
      • SE:  tremor, polyuria, nausea, diarrhea, gait disturbance, tachyphylaxis (w/ LT use)
      • Caution:  dehydration, Na-restriction

Transitional prophylaxis/rapid suppression:  corticosteroids & ergot alkyloids (ergotamine–lower risk of ergotism & methysegide–refractory HA only)

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