Neurology Book

http://www.fpnotebook.com/

Cluster Headache

Aka: Cluster Headache
  1. See Also
    1. Acute Recurrent Headache
    2. Migraine Headache
    3. Headache
  2. Pathophysiology
    1. Migraine Variant
  3. Types
    1. Cluster Headache
      1. Episodic (90%)
        1. Remission periods last at least one month
      2. Chronic (10%)
        1. Headaches occur for more than one year
        2. Remissions last <1 month
    2. Cluster Headache Variants
      1. Hemicrania continua (or Paroxysmal hemicrania)
  4. Epidemiology
    1. More common in men
    2. Onset in men occurs in ages 20 to 40
    3. Onset in women peaks in the 60s
      1. More common in black women
  5. Risk Factors
    1. Tobacco abuse
    2. Family History of Headache
    3. Head Injury
    4. Shift work
  6. Symptoms
    1. Characteristics
      1. Deep pain
      2. Burning or stabbing type pain
    2. Severity: Excruciating pain ("SuicideHeadache")
      1. Patient may even consider Suicide
    3. Location
      1. Unilateral Headache
      2. Orbital, supraorbital or temporal pain
      3. Radiates to upper teeth, jaw or neck
    4. Timing
      1. At least 5 attacks within 10 days
      2. Multiple daily episodes may occur (up to 8 per day)
      3. Headaches last 15 minutes to 180 minutes
      4. Usually recur at same time of day each day
      5. May awaken patient from sleep (esp. onset of REM)
      6. Remissions for months to years
    5. Triggers
      1. Sleep Apnea
      2. Vasodilators
        1. Nitroglycerin
        2. Alcohol
    6. Associated with at least one of the following
      1. Lacrimation
      2. Ipsilateral facial Flushing or sweating
      3. Ipsilateral Nasal discharge
      4. Affected eye red with dilated Conjunctival vessels
      5. Restlessness, pacing or rocking head in hands
      6. Horner's Syndrome
        1. Ipsilateral Ptosis
        2. Ipsilateral pupillary constriction (Miosis)
  7. Evaluation
    1. See Headache Evaluation
  8. Differential Diagnosis
    1. Migraine Headache
      1. Common features do not distinguish from cluster
        1. Aura occurs in 14% of Cluster Headaches
        2. Photophobia occurs in >50% of Cluster Headaches
    2. Hemicrania continua (or Paroxysmal hemicrania)
      1. Cluster-type Headache with brief duration
      2. Responds well to Indomethacin
    3. Orbital Myositis
      1. Similar to Cluster Headache with longer duration
  9. Management: Abortive Treatment (See Migraine Treatment)
    1. First line agents
      1. Sumatriptan (Imitrex)
        1. Subcutaneous: 6 mg SC
        2. Intranasal 20 mg
      2. Oxygen Inhalation
        1. Dose: 7 liters per minute for 15 minutes
    2. Other agents
      1. Intranasal Lidocaine 4-10% solution
        1. Dose: 1 ml intranasally
          1. Aplied with cotton swab bilaterally for 5 minutes
        2. May be repeated twice in 15 minutes prn
        3. Relieves pain within 5-15 minutes
        4. Costa (2000) Cephalalgia 20:85-91
      2. Intranasal Dihydroergotamine 0.5 mg bilateral nares
        1. Reduces Headache severity
        2. Does not decrease cluster frequency or duration
        3. Andersson (1986) Cephalalgia 6:51-4
      3. Intranasal Capsaicin
        1. Applied to ipsilateral nostril bid for 7 days
        2. Marks (1993) Cephalalgia 13:114-6
      4. Indomethacin
        1. Dose: 25-50 mg tid prn
        2. Effective also in Cluster Headache variants
  10. Management: Prophylaxis for Episodic Cluster Headaches
    1. See Migraine Prophylaxis
    2. First-line agents
      1. Corticosteroids
        1. Dose: 60 mg on days 1-3
        2. Tapering over 10-14 days
      2. Verapamil
        1. Start: 80 mg PO tid
        2. Increase to 120 to 160 mg PO tid
    3. Other agents
      1. Anticonvulsants
        1. Valproic Acid
        2. Topiramate (Topamax)
        3. Gabapentin (Neurontin)
      2. Indomethacin
        1. Dose: 25-50 mg tid
    4. Avoid agents with serious adverse effects
      1. Methylsergide
        1. No longer recommended due to systemic fibrosis
  11. Management: Prophylaxis for Chronic Cluster Headaches
    1. Verapamil
      1. Start: 80 mg PO tid
      2. Increase to 120 to 160 mg PO tid
    2. Lithium
      1. Dose: 300-600 mg/day initially (Maximum 900 mg/day)
      2. Base dose on serum Lithium levels
    3. Microvascular decompression surgery
  12. Management: Nonpharmacologic measures
    1. Relaxation techniques
    2. Cognitive-behavior therapy
    3. Treat comorbid Mood Disorders
    4. Alcohol cessation
  13. References
    1. Beck (2005) Am Fam Physician 71:717-28
    2. Dalessio (2001) Postgrad Med 109(1):69-78
    3. Dodick (2000) Cephalalgia 20(9): 787-803
    4. Zakrzewska (2001) Br J Oral Maxillofac Surg 39:103-13

Cluster Headache (C0009088)

Definition (MSH) A primary headache disorder that is characterized by severe, strictly unilateral PAIN which is orbital, supraorbital, temporal or in any combination of these sites, lasting 15-180 min. occurring 1 to 8 times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, facial SWEATING, eyelid EDEMA, and miosis. (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1)
Concepts Disease or Syndrome (T047)
MSH D003027
ICD9 339.02, 339.00
ICD10 G44.0, G44.02, G44.00, G44.029, G44.009
SnomedCT 193034001, 193032002, 55865003, 193031009, 193947008, 230473009, 155048007, 267699004
English Headaches, Cluster, CLUSTER HEADACHES, BING-HORTON SYNDROME, CEPHALALGIA, HISTAMINE, CEPHALALGIA, PAROXYSMAL, NOCTURNAL, ORBITAL, CLUSTER HEADACHE, Cluster Headaches, ERYTHROPROSOPALGIA, HEADACHE HISTAMINE, HEADACHE VASOMOTOR, HISTAMINE HEADACHE, HORTON SYNDROME, HORTON'S HEADACHE, Headache, Cluster, Hortons Syndrome, Cluster Headache, cluster headache (diagnosis), cluster headache, Cluster headache (disorder), Cluster headache syndrome, unspecified, Cluster headaches, Headaches cluster, Headache histamine, Headache vasomotor, HEADACHE CLUSTER, Cephalgia, Histamine, Histamine Cephalgia, Cephalgias, Histamine, Histamine Cephalgias, Chronic Cluster Headache, Chronic Cluster Headaches, Cluster Headache, Chronic, Cluster Headaches, Chronic, Headache, Chronic Cluster, Headaches, Chronic Cluster, Ciliary Neuralgia, Neuralgia, Ciliary, Ciliary Neuralgias, Neuralgias, Ciliary, Cluster Headache Syndrome, Cluster Headache Syndromes, Headache Syndrome, Cluster, Headache Syndromes, Cluster, Syndrome, Cluster Headache, Syndromes, Cluster Headache, Horton Syndrome, Horton's Syndrome, Syndrome, Horton, Syndrome, Horton's, Migraine, Neuralgic, Migraines, Neuralgic, Neuralgic Migraine, Neuralgic Migraines, Cluster headache syn NOS, Cluster headache NOS, Chronic cluster headache NOS, Cluster headache syndrome NOS, Cluster Headache [Disease/Finding], horton's neuralgia, headache cluster, headaches cluster, hortons syndrome, Headache;cluster, chronic cluster headaches, clusters headache, migrainous neuralgia, cluster headache syndrome, headaches histamine, histamine cephalgia, horton's headache, horton syndrome, chronic cluster headache, horton's syndrome, headache histamine, Histamine headache, Cluster headache, Ciliary neuralgia, Histamine cephalgia, Horton's headache, Horton's neuralgia, Migrainous neuralgia, Cluster headache syndrome, Neuralgic migraine, Chronic cluster headache, Vasomotor headache, Chronic cluster headache (disorder), Ciliary neuralgia (disorder), Cluster headache syndrome (disorder), histamine headache, Horton, ciliary; neuralgia, cluster; headache, headache; cluster, headache; histamine, histamine; headache, migrainous; neuralgia, neuralgia; ciliary, neuralgia; migrainous, syndrome; cluster headache, Cluster headache (disorder) [Ambiguous], cluster; headache syndrome, cluster headaches
Portuguese CEFALEIA HISTAMINICA, Cefaleias cluster, Cefaleia histamínica, Cefaleia vasomotora, Nevralgia tipo enxaqueca, CEFALEIA DE HORTON, CEFALEIA VASOMOTORA, CEFALEIAS EM SALVA, Cefaleia de Horton/cluster, Cefaleia de Horton, Cefalalgia Histamínica, Cefaléia em Cacho, Cefaléia Histamínica, Cefalgia Histamínica, Enxaqueca Nevrálgica, Nevralgia Ciliar, Síndrome de Horton
Dutch hoofdpijn histamine, hoofdpijn cluster, migraineuze neuralgie, Hortonse hoofdpijn, hoofdpijn vasomotorisch, Cluster headache, ciliair; neuralgie, cluster; hoofdpijn, histamine; hoofdpijn, hoofdpijn; cluster, hoofdpijn; histamine, migraine-achtig; neuralgie, neuralgie; ciliair, neuralgie; migraine-achtig, syndroom; clusterhoofdpijn, Cluster-hoofdpijnsyndroom, cluster hoofdpijn, cluster; hoofdpijnsyndroom, Ciliaire neuralgie, Clusterhoofdpijn, Histamine-cefalgie, Hoofdpijn, cluster-, Horton, neuralgie van, Neuralgie van Horton, Neuralgische migraine
French Neuralgie migraineuse, Algies vasculaires de la face, Céphalée vasomotrice, Céphalée de Horton, ALGIES VASCULAIRES DE LA FACE, CEPHALEE HISTAMINIQUE, CEPHALEE VASOMOTRICE, CEPHALEES DE HORTON, Cephalee de Horton, Céphalée vasculaire de Horton, Algie vasculaire de la face, Céphalée histaminique, AVF (Algie Vasculaire de la Face), Syndrome de Bing-Horton
German Cluster-Kopfschmerzen, vasomotorischer Kopfschmerz, Clusterkopfschmerzen, Histaminkopfschmerz, Horton-Kopfschmerzen, migraeneartige Neuralgie, CLUSTERKOPFSCHMERZEN, HISTAMINKOPFSCHMERZ, HORTONSCHER KOPFSCHMERZ, KOPFSCHMERZEN VASOMOTORISCH, Cluster-Kopfschmerz, Histamin-Kopfschmerz, Histaminbedingte Zephalgie, Horton-Syndrom, Kopfschmerz, Cluster-, Neuralgische Migraine, Ziliarneuralgie
Italian Cefalea da istamina, Nevralgia emicranica, Cefalee a grappolo, Cefalea vasomotoria, Cefalgia istaminica, Cefalea a grappolo cronica, Cefalea di Horton, Emicrania nevralgica, Neuralgia ciliare, Cefalea a grappolo
Spanish Cefalea vasomotora, Cefalea por histamina, Cefalea en brotes, Cefalea en acúmulos, Neuralgia migrañosa, Cefalea de Horton, cefalea crónica salvas, Cluster headache syndrome, Migrainous neuralgia, Cluster headaches, CEFALEA DE HORTON, CEFALEA HISTAMINICA, CEFALEA VASOMOTORA, Cefalea arracimada, cefalalgia histamínica, cefalea acuminada (concepto no activo), cefalea acuminada (trastorno), cefalea acuminada, cefalea crónica salvas (trastorno), cefalea de Horton crónica, cefalea de Horton, cefalea en acúmulos, cefalea en grupos, cefalea en racimos crónica, cefalea en racimos, cefalea en salvas (trastorno), cefalea en salvas crónica (trastorno), cefalea en salvas crónica, cefalea en salvas, cefalea en tandas crónica, cefalea en tandas, cefalea histaminérgica crónica, cefalea histaminérgica, cefalea histamínica crónica, cefalea histamínica, cefalea vasomotora, migraña neurálgica crónica, migraña neurálgica, neuralgia ciliar (trastorno), neuralgia ciliar, neuralgia con migraña, neuralgia de Horton, Cefalea en racimos, Cefalalgia en Racimos, Cefalalgia Histamínica, Cefalea Histamínica, Neuralgia Ciliar, Neuralgia Migrañosa, Síndrome de Horton, Cefalalgia Histaminica, Cefalea Histaminica, Neuralgia Migranosa, Sindrome de Horton
Swedish Klusterhuvudvärk, CLUSTERHUVUDVARK
Japanese ｸﾞﾝﾊﾟﾂｽﾞﾂｳ, ﾎｰﾄﾝｽﾞﾂｳ, ｹｯｶﾝｳﾝﾄﾞｳｾｲｽﾞﾂｳ, ﾍﾝｽﾞﾂｳｾｲｼﾝｹｲﾂｳ, ｸﾞﾝﾊﾂｽﾞﾂｳ, ﾋｽﾀﾐﾝｾｲｽﾞﾂｳ, クラスター頭痛, 頭痛-群発, ヒスタミン性頭痛, ホートン症候群, ホートン頭痛, 片頭痛性神経痛, 群発頭痛, 自律神経性頭痛, 血管運動性頭痛, 錐体神経痛, ホルトン症候群, 群発性頭痛, 頭痛-自律神経性
Czech migréna sdružená, cluster headache, Cluster headache, Hortonova bolest hlavy, Histaminová bolest hlavy, Vazomotorická bolest hlavy, Migrenózní neuralgie
Finnish Sarjoittainen päänsärky, CLUSTER PAANSARKY
Russian GOLOVNAIA BOL' GROZDEOBRAZNAIA, GOLOVNAIA BOL' GISTAMINOVAIA, TSILIARNAIA NEVRALGIIA, GISTAMINOVAIA GOLOVNAIA BOL', KHORTONA SINDROM, TSEFALGIIA GISTAMINOVAIA, GOLOVNAIA BOL' KLASTERNAIA, ГИСТАМИНОВАЯ ГОЛОВНАЯ БОЛЬ, ГОЛОВНАЯ БОЛЬ ГИСТАМИНОВАЯ, ГОЛОВНАЯ БОЛЬ ГРОЗДЕОБРАЗНАЯ, ГОЛОВНАЯ БОЛЬ КЛАСТЕРНАЯ, ХОРТОНА СИНДРОМ, ЦЕФАЛГИЯ ГИСТАМИНОВАЯ, ЦИЛИАРНАЯ НЕВРАЛГИЯ
Norwegian CLUSTER-HODEPINE/HORTONS SYNDROM
Danish Cluster-hovedpine/Hortons syndrom
Hungarian gorcsos fejfajas, Cluster fejfájások, Horton-fejfájás, Migraines neuralgia, Histamin fejfájás, Vasomotoros fejfájás, Cluster fejfájás
Korean 송이두통 증후군
Basque HORTONEN ZEFALEA
Polish Hemikrania naczynioporaźna, Neuralgia nerwu skalistego, Ból głowy klasterowy, Neuralgia nerwu rzęskowego, Ból głowy Hortona
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Navigation Tree