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Cluster headache

A variety of names have been used for this condition, including Raeder's syndrome, histamine cephalalgia, and sphenopalatine neuralgia. Cluster headache is a distinctive and treatable vascular headache syndrome.

Clinical picture

Cluster headache is usually episodic and unilateral (on one side).

Short lived attacks of extremely severe unilateral headache (mainly periorbital - around the eyes) occurring in clusters many times a day (characteristically during the night, one / two hours after sleep) at exactly the same time for weeks only to remit for months or years (avarage 1 year).

Differential diagnosis

Cluster headaches can be confused with migraines. However, in cluster headaches the patient is restless unlike in migraine.

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Therapy can be established due to the expected timing of attacks.

The most satisfactory treatment is the administration of drugs to prevent cluster attacks until the bout is over. Effective prophylactic drugs are prednisone, lithium, methysergide, ergotamine, sodium valproate, and verapamil. Lithium (600 to 900 mg daily) appears to be particularly useful for the chronic form of the disorder. A 10-day course of prednisone, beginning at 60 mg daily for 7 days followed by a rapid taper, may interrupt the pain bout for many patients. When ergotamine is used, it is most effective when given 1 to 2 h before an expected attack. Patients must be educated regarding the early symptoms of ergotism when ergotamine is used daily; a weekly limit of 14 mg should be adhered to.

For the attacks themselves, oxygen inhalation (9 L/min via a loose mask) is the most effective modality; 15 min of inhalation of 100% oxygen is often necessary. Sumatriptan, 6 mg subcutaneously, will usually shorten an attack to 10 to 15 min.

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