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Cluster Headache
Extremely painful unilateral headaches which occur in clusters throughout the day and may continue for months.
Pain is on the level with passing kidney stones and childbirth.
Ther term cluster refers to the fact that symptoms are cyclical or come in clusters
Clinical Presentation
- Sudden onset of unilateral, extremely painful, headaches which come and go but usually last between 15 minutes and 3 hours.
- They usually come in “clusters” and occur on schedule each dayn
- Pain is often around or behind the eye
- Other symptoms
- Runny nose
- Watery eyes
- Drooping eyelid
- Blushing
Labs, Studies and Physical Exam Findings
- A good history
Treatment
- Acute attacks
- Oxygen
- Triptans
- Sumatriptan
- Zolmitriptan
- Steroids may be helpful
- Opioids are just as likely to make things worse
- Preventive therapy
- Calcium channel blockers – Verapamil
Migraine Headache
- Typically unilateral headache of moderately severe pulsating pain.
- Auro occurs in about 30% of patients
- Classic migraine = aura
- Common migraine = no auro
- Usually lasts between 2 and 72 hours
- There is often a family history of migraines
- Before puberty more boys than girls. After puberty more women than men.
Clinical Presentation
- Recurrent severe headaches
- “It’s worse if I move at all”
- Nausea/vomiting
- Sensitivity to light and sound
Labs, Studies and Physical Exam Findings
- Imaging is not necessary
Treatment
- Acute migraine or abortive therapy
- NSAIDs – Ibuprofen
- Aspirin
- Caffeine
- Triptans – serotonin receptor agonists
- Sumatriptan
- Ergotamine
- Dexamethasone
- Prophylactic treatment
- Beta blockers – metoprolol, propranolol
- Calcium Channel blockers – verapamil
- ACE inhibitors
- Tricyclic antidepressants
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