Cluster headaches are severe and unbearable unilateral headaches, usually centred around the eye.
They are called cluster headaches as they come in clusters of attacks and then disappear for extended periods. For example, a patient may suffer 3-4 episodes a day for weeks or months, followed by a pain-free period lasting several years. Attacks last between 15 minutes and 3 hours.
A typical patient is a 30-50 year old male smoker. They may have triggers, such as alcohol, strong smells or exercise.
Symptoms
Cluster headaches cause severe pain. They are sometimes called “suicide headaches” due to their severity.
Associated symptoms are typically unilateral:
- Red, swollen and watering eye
- Pupil constriction (miosis)
- Eyelid drooping (ptosis)
- Nasal discharge
- Facial sweating
Management
Treatment options during acute attacks are:
- Triptans (e.g., subcutaneous or intranasal sumatriptan)
- High-flow 100% oxygen (may be kept at home)
Verapamil is the first line for prophylaxis (to prevent attacks).
Other options for prophylaxis are:
- Occipital nerve block
- Prednisolone (e.g., a short course to break the cycle during clusters)
- Lithium
Last updated October 2023
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