Cluster Headache

CLUSTER HEAD ACHE (MIGRAINOUS NEURALGIA)
Etiology:
Cluster headache is likely a disorder involving central pacemaker neurons in the region of the posterior hypothalamus, causing excruciating henticranial pain.
Symptoms:
  • Young adult men
  • The pain is unilateral, deep, usually retro orbital, excruciating, non-fluctuating and explosive in quality
  • A core feature of cluster headache is periodicity. Pain recurs at the same hour each day for 8 to 10 weeks a year; followed by a pain-free interval
  • Patients are generally perfectly well between episodes
  • Often occurs at night 2 hrs after sleep, wakes up the patient from sleep

  • Associated with vasomotor phenomenon – rhinorrhea, conjunctival injection, nasal congestion, lacrimation, ptosis or Horner's syndrome
  • These defects occur due to parasympathetic activation which occur as a result of injury to ascending sympathetic fibers surrounding a dilated carotid artery as it passes into the cranial cavity.
Treatment:
  • Prednisone used for short term prevention; verapamil for long term prevention
Exam Question
Symptoms:
  • Young adult men
  • The pain is unilateral, deep, usually retro orbital, excruciating, non-fluctuating and explosive in quality
  • A core feature of cluster headache is periodicity. Pain recurs at the same hour each day for 8 to 10 weeks a year; followed by a pain-free interval
  • Patients are generally perfectly well between episodes
  • Often occurs at night 2 hrs after sleep, wakes up the patient from sleep
  • Associated with vasomotor phenomenon – rhinorrhea, conjunctival injection, nasal congestion, lacrimation, ptosis or Horner's syndrome

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