Cluster Headaches

Question 1

What are the typical features of cluster headaches?

Answer 1

• Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
• Clusters typically last 4-12 weeks
• Intense pain around one eye (recurrent attacks ‘always’ affect same side)
• Patient is restless during an attack
• Accompanied by redness, lacrimation, lid swelling
• Nasal stuffiness
• Miosis and ptosis in a minority

Question 2

What is your management pathway for cluster headaches?

Answer 2

• Acute: 100% oxygen, subcutaneous or a nasal triptan
• Prophylaxis: verapamil, prednisolone
• NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging or other specialist conditions that can mimic cluster headaches.