Vascular headache - Clinicals, Diagnosis, and Management

Neurology

Clinicals - History

Fact Explanation
Episodic headache (occurring in clusters). Symptoms occur repeatedly for a few weeks, followed by a symptom free period of a few months before another cluster occurs; thus differentiating it from migraine which is also unilateral. Episodic headache (occurring in clusters).
Symptoms occur repeatedly for a few weeks, followed by a symptom free period of a few months before another cluster occurs; thus differentiating it from migraine which is also unilateral.
Severe, unilateral periorbital pain, which is boring in character. Due to trigeminal nerve involvement. Severe, unilateral periorbital pain, which is boring in character.
Due to trigeminal nerve involvement.
Episodes are characteristically brief (30-90 minutes). Characterized by recurrent attacks that last 15 to 180 minutes and are recurrent (1 every other day to 8 per day). Episodes are characteristically brief (30-90 minutes).
Characterized by recurrent attacks that last 15 to 180 minutes and are recurrent (1 every other day to 8 per day).
Symptoms present at determined hours, and are commonly nocturnal. There's evidence pointing to Hypothalamic involvement; the Hypothalamus predominantly participates in regulation of several biological and specifically circadian cycles. Symptoms present at determined hours, and are commonly nocturnal.
There's evidence pointing to Hypothalamic involvement; the Hypothalamus predominantly participates in regulation of several biological and specifically circadian cycles.
Patients are quite restless at the time of the attack. This symptom differentiates cluster headache from migraine where the patient prefers a calm and quiet environment. Patients are quite restless at the time of the attack.
This symptom differentiates cluster headache from migraine where the patient prefers a calm and quiet environment.
Commonly associated with ipsilateral conjunctival injection, lacrimation, rhinorrhoea and nasal congestion. Due to autonomic nervous system dysfunction. Commonly associated with ipsilateral conjunctival injection, lacrimation, rhinorrhoea and nasal congestion.
Due to autonomic nervous system dysfunction.

Clinicals - Examination

Fact Explanation
Ipsilateral horner's syndrome at the time of an attack. Due to autonomic disturbance. Ipsilateral horner's syndrome at the time of an attack.
Due to autonomic disturbance.
Ipsilateral conjunctival injection and lacrimation during an attack. Due to autonomic disturbance. Ipsilateral conjunctival injection and lacrimation during an attack.
Due to autonomic disturbance.

Investigations - Diagnosis

Fact Explanation
Erythrocyte sedimentation rate (ESR) To exclude Giant Cell Arteritis, which is an emergency; a very high ESR would be suggestive of Giant Cell Arteritis. Erythrocyte sedimentation rate (ESR)
To exclude Giant Cell Arteritis, which is an emergency; a very high ESR would be suggestive of Giant Cell Arteritis.
Tonometry This detects high intra-ocular pressures which occur in glaucoma. Tonometry
This detects high intra-ocular pressures which occur in glaucoma.

Management - Supportive

Fact Explanation
Avoid triggers such as alcoholic beverages. Alcohol as well as other substances such as histamines and nitrates are known to trigger bouts of cluster headaches. Avoid triggers such as alcoholic beverages.
Alcohol as well as other substances such as histamines and nitrates are known to trigger bouts of cluster headaches.
Apply temporal pressure. Gives symptomatic relief to the patient. Apply temporal pressure.
Gives symptomatic relief to the patient.
Apply heat to the eye. GIves symptomatic relief to the patient. Apply heat to the eye.
GIves symptomatic relief to the patient.

Management - Specific

Fact Explanation
100% oxygen. Oxygen has the ability to constrict distal cerebral resistance vessels. It can also act as a serotonergic agonist and an immunomodulator of substance P. 100% oxygen.
Oxygen has the ability to constrict distal cerebral resistance vessels. It can also act as a serotonergic agonist and an immunomodulator of substance P.
Subcutaneous sumatriptan. Triptans act as serotoninergic receptor agonists and inhibit trigeminal nerve endings, thereby reducing the pain. Subcutaneous sumatriptan.
Triptans act as serotoninergic receptor agonists and inhibit trigeminal nerve endings, thereby reducing the pain.

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