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Updated: Dec 30 2021

Cluster Headache

  • Snapshot
    • A 36-year-old man presents with recurrent bouts of left-sided severe lancinating periorbital pain. His symptoms began 20 minutes prior, and appears to occur daily for the past several weeks. During his headache episodes, he constantly tears, and has a “runny nose.” Miosis, ptosis, and conjunctival injection is appreciated on exam.
  • Introduction
    • Primary headache disorder characterized by
      • unilateral periorbital pain
      • ipsilateral cranial autonomic manifestations
        • e.g., lacrimation, rhinorrhea, miosis, and ptosis
      • circadian rhythmicity
    • A type of trigeminal autonomic cephalalgias (TACs)
    • Typically lasts 15-180 minute
      • occurs in "clusters" (or bouts)
  • Epidemiology
    • More common in men
    • Onset typically 10 - 39 years old
  • Presentation
    • Symptoms
      • severe, excruciating, lancinating periorbital pain
      • strictly unilateral
      • restless
      • circadian rhythmicity
        • can occur daily, with or without remission
  • Differential
    • Migraine headache
    • Trigeminal neuralgia
  • DIAGNOSIS
    • Clinical diagnosis
  • Treatment
      • Treatment
      • Acute (Abortive) Therapy
      • Preventive Prophylactic Therapy
      • 100% O2
      •   Triptans
      • Lithium
      • Melatonin
  • Complications
    • Medication overuse headaches
  • Prognosis
    • Affects quality of life
    • As a person ages, frequency may decline
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