- Male gender (3:1)
Alcohol may trigger an attack and there also appears to be a relation to nocturnal sleep.
- Intense sharp, stabbing pain around one eye (recurrent attacks 'always' affect same side)
- Typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
- Clusters typically last 4-12 weeks
- Patient is restless and agitated during an attack
- Often accompanied by redness, nasal stuffiness, lacrimation, lid swelling
- Miosis and ptosis in a minority
- 100% oxygen (80% response rate within 15 minutes), subcutaneous triptan (75% response rate within 15 minutes)
- Verapamil is the drug of choice
- There is also some evidence to support a tapering dose of prednisolone
- NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches with respect to neuroimaging
Some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). It is recommended such patients are referred for specialist assessment as specific treatment may be required, for example it is known paroxysmal hemicrania responds very well to indomethacin.