TOTAL EM
  • Emergency Professionals
  • For The Public
  • Our Friends
  • About Us and Disclaimer
  • Twitter
  • LinkedIn
  • Facebook
  • Contact Us

Emergency Professionals

Podcast #242 - 10 Key Pearls for Cluster Headaches

6/15/2022

0 Comments

 
Picture
Cluster headaches are often considered one of the most painful human experiences.  They are short (lasting usually 15-180 minutes), frequent (up to 8 a day), unilateral headaches behind or around the eye often with ipsilateral autonomic symptoms and restlessness.  While migraines and tension headaches are seen frequently in the emergency department, cluster headaches are much less frequently seen and often are harder to identify as a result.  There are certain points to remember with patients that are experiencing cluster headaches and we list 10 of them here.
These pearls come from a recent BMJ article title Recent Advances in the Diagnosis and Management of Cluster Headache by Emmanuelle Schindler and Mark Burish. 

  1. Suicidal ideation (SI) occurs in 55-64% of patients and self-injurious behavior is often seen.
  2. Cluster headaches are associated with smoking, but cessation does not alter the disease.
  3. There are episodic and chronic types:
    1. Episodic occurs only during a period of weeks to months often in an annual cycle and accounts for approximately 80% of cases.
    2. Chronic accounts for the other approximately 20% and occurs throughout the year without remission.
  4.  There are certain clinical features that can help distinguish and identify cluster headaches:
    1. Preattack "shadows" with symptoms present shortly prior to the actual attack (ipsilateral aching, lacrimation, and nasal congestion often seen minutes before) and further out (such as an hour) there are generalized symptoms including difficulty concentrating and mood changes.
    2. Mild symptoms may remain between these attacks.
    3. There is often restlessness which helps differentiate it from migraines.
    4. Self injurious behaviors are often seen (but unrelated to SI) such as hitting or rubbing head, punching walls, and cutting or piercing skin.
    5. Dysautonomia is also seen where there are changes in autonomic tone including bradycardia, altered tilt table testing, and nocturnal lipolysis.
  5. Approximately 80% of patients can predict when attacks occur (often around 2-3 AM), have an annual rhythm (often less common in summer months), and daylight hours are associated in general with fewer attacks.
  6. There are common triggers (chemical, environmental, and physiologic) that are often noted, but it may not have effect outside of the attack cycle:
    1. The most common chemical trigger is alcohol (EtOH) which usually occurs within an hour, nitroglycerin, PDE5 inhibitors, and strong smells (such as cleaners or perfumes).
    2. Environmental triggers often include high altitude, weather changes, or bright sunlight.
    3. Physiologic triggers include sleep, circadian rhythm disruption (such as shift work, jet lag, and time changes), stress, relaxation, menstruation, menopause, postpartum, and low testosterone. 
  7. Brain MRI can help rule out secondary causes and if refractory consider other testing such as MRA of the head and neck, pituitary lab tests, sleep study for obstructive sleep apnea, and if Horner syndrome is present image the lung apex.
  8. Acute treatment includes sumatriptan, oxygen (often 6-12 L/min), and noninvasive vagus nerve stimulation.
  9. Transitional treatments include steroids (including occipital nerve injection) and dihydroergotamine.
  10. Preventative treatments include a variety of medications that can be used if chronic cases or before typical period of episodes which includes verapamil, lithium, melatonin, capsicum, topiramate, baclofen, and galcanezumab. 

You can learn more by clicking on the link above or downloading the PDF listed below.

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on Apple Podcasts.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.
Podcast #242
File Size: 9447 kb
File Type: mp3
Download File

Recent Advances in the Diagnosis and Management of Cluster Headache
File Size: 621 kb
File Type: pdf
Download File

0 Comments



Leave a Reply.

    Libsyn and iTunes

    We are now on Libsyn and iTunes ​for your listening pleasure!

    Archives

    July 2022
    June 2022
    June 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016

    Categories

    All

    Picture

    RSS Feed

Our Pages

Emergency Professionals
For the Public
Our Friends

Support

About Us and Disclaimer
Contact Us
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
  • Emergency Professionals
  • For The Public
  • Our Friends
  • About Us and Disclaimer
  • Twitter
  • LinkedIn
  • Facebook
  • Contact Us