Cluster Headaches

Type Comments Treatment
Cluster - Male
- severe unilateral pain that lasts from 15 minutes to 3 hours
- extremely sharp, continuous, and incapacitating
- Headaches are associated with at least one of the following ipsilateral signs:
  conjunctival injection
  nasal congestion

  ptosis, eye edema, and forehead and facial sweating
- Sumatriptan : 6 mg subcutaneously as a single dose, may repeat at least one hour after initial dose if required, maximum 12 mg/day
- Oxygen
- Sumatriptan nasal : 5-20 mg in one nostril as a single dose, may repeat at least 2 hours after initial dose if required, maximum 40 mg/day
- zolmitriptan : 2.5 to 5 mg orally as a single dose, may repeat at least 2 hours after initial dose if required, maximum 10 mg/day

Pt with CVA:
- lidocaine : 1 mL of a 10% lidocaine solution placed with a cotton swab intranasally (ipsilaterally/bilaterally) for 5 minutes


  1. Not completely understood
  2. Risk factors/triggers
  3. Epidemiology
  4. Morbidity/mortality


Acute Treatment

  1. O2 8-12 L/min by mask: TOC
  2. Medications (abortive)


Further Management

Follow-Up Care

  1. Follow up w/ PCP, Neuro as appropriate
  2. Prophylaxis: during cluster period until 2 wks attack free

ITE 2013, Q73

A 21-year-old male presents with a complaint of headaches for the past 6 months. He has severe, sharp, right-sided periorbital pain 3–4 days each week. When these headaches occur his right eye gets watery, his right nostril feels clogged, and his forehead feels sweaty. When he gets the headaches he takes four 200-mg ibuprofen tablets and goes into a dark, quiet room. The headaches usually resolve in about 90 minutes. Currently he is feeling well and his examination is completely normal.
What type of headache does he most likely have?

A) Medication overuse headache
B) Migraine
C) Paroxysmal hemicrania
D) Temporal arteritis
E) Cluster headache