Cluster Headache: A Neurological Overview
Description: Intense, severe unilateral headache in regions like supraorbital, retro-orbital, and temporal.
Pain Level: Often described as the worst headache ever, comparable to childbirth or fractures.
Duration: Lasts 15 to 180 minutes when untreated, occurring up to 8 times a day.
Associated Symptoms: Agitation, restlessness, autonomic symptoms like lacrimation, rhinorrhea, and ptosis.
Triggers: Alcohol, nitrates, strong odors.
Pathophysiology: Involves trigeminal nerve and hypothalamic activation.
Treatment: High-flow oxygen for acute attacks, verapamil for prevention.
Differential Diagnosis:
- Other Trigeminal Autonomic Cephalalgias: Paroxysmal hemicrania, SUNCT, SUNA.
- Other Headaches: Migraines, trigeminal neuralgia.
Investigations: MRI Brain
Treatment Approach:
- Acute Attack: High-flow oxygen, sumatriptan.
- Interim Treatment: Steroids, occipital nerve block.
- Preventative Treatment: Verapamil, CGRP monoclonal antibodies.
Conclusion: Cluster headaches are severe, unilateral headaches with associated autonomic features, involving the trigeminal autonomic reflex and hypothalamic activation. Treatment includes high-flow oxygen for acute attacks and preventative strategies using verapamil.