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Recognition and treatment of cluster headache in the emergency department

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Abstract

Cluster headache has a dramatic presentation marked by rapidly escalating intensity of pain and prominent signs of autonomic dysfunction. Despite its distinctive features, diagnostic delay and misdiagnosis are common. Prompt recognition of this headache disorder provides an opportunity for effective treatment. This article provides a practical approach to the diagnosis and management of patients with cluster headache in the emergency room setting.

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References and Recommended Reading

  1. Barton CW: Evaluation and treatment of headache patients in the emergency department: a survey. Headache 1994, 34:91–94.

    Article  PubMed  CAS  Google Scholar 

  2. Ward T, Levin M, Phillips JM: Evaluation and management of headache in the emergency department. Med Clin North Am 2001, 85:971–996.

    Article  PubMed  CAS  Google Scholar 

  3. Russell MB: Genetic epidemiology of migraine and cluster headache. Cephalalgia 1997, 17:683–701.

    Article  PubMed  CAS  Google Scholar 

  4. Ekbom K, Ahlborg B, Schele R: Prevalence of migraine and cluster headache in Swedish men of 18. Headache 1978, 18:9–19.

    Article  PubMed  CAS  Google Scholar 

  5. Tonon C, Guttmann S, Volpini M, et al.: Prevalence and incidence of cluster headache in the Republic of San Marino. Neurology 2002, 58:1407–1409.

    PubMed  CAS  Google Scholar 

  6. Swanson J, Yanagihara T, Stang P, et al.: Incidence of cluster headache: a population-based study of Olmstead County, Minnesota. Neurology 1994, 44:433–437.

    PubMed  CAS  Google Scholar 

  7. Manzoni GC: Cluster headache and lifestyle: remarks on a population of 374 male patients. Cephalalgia 1999, 19:88–94.

    Article  PubMed  CAS  Google Scholar 

  8. Manzoni GC: Gender ratio of cluster headache over the years: a possible role of changes in lifestyle. Cephalalgia 1998, 18:138–142.

    Article  PubMed  CAS  Google Scholar 

  9. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 2003, 24(suppl 1):1–160.

    Google Scholar 

  10. Bahra A, May A, Goadsby PJ: Cluster headache: a prospective clinical study with diagnostic implications. Neurology 2002, 58:354–361. A well-performed study addressing the clinical manifestations of this disorder, the patient population affected, and treatment regimens.

    PubMed  Google Scholar 

  11. Dodick DW, Rozen TD, Goadsby PJ, Silberstein SD: Cluster headache. Cephalalgia 2000, 20:787–803. A superb review of cluster headache, its clinical features, putative pathogenesis, and management.

    Article  PubMed  CAS  Google Scholar 

  12. Dodick DW, Capobianco DJ: Treatment and management of cluster headache. Curr Pain Headache Rep 2001, 5:83–91.

    PubMed  CAS  Google Scholar 

  13. Russell D: Cluster headache: severity and temporal profiles of attacks and patients’ activity prior to and during attacks. Cephalalgia 1981, 1:209–216.

    Article  PubMed  CAS  Google Scholar 

  14. van Vliet J, Eekers P, Haan J, et al.: Epidemiology and clinical spectrum of cluster headache and CH-like syndromes in The Netherlands: a nationwide study in 1844 patients. Cephalalgia 2001, 21:495.

    Google Scholar 

  15. Kudrow L: Cluster Headache: Mechanisms and Management. New York: Oxford University Press; 1980.

    Google Scholar 

  16. Ekbom K: A clinical comparison of cluster headache and migraine. Acta Neurol Scand 1970, Supplement 41:7–48.

    Google Scholar 

  17. Dexter JD, Riley TL: Studies in nocturnal migraine. Headache 1975, 15:51–62.

    Article  PubMed  CAS  Google Scholar 

  18. Kudrow L, McGinty DJ, Phillips ER, Stevenson M: Sleep apnea in cluster headache. Proceedings of the 12th Scandinavian Migraine Society Meeting. Helsinki: June 17–18, 1984:56.

  19. Blau JN, Engel HO: Premonitory and prodromal symptoms in cluster headache. Cephalalgia 1998, 18:91–93.

    Article  PubMed  CAS  Google Scholar 

  20. Raimondi E: Cluster headache: premonitory symptoms. Headache 1999, 39:565–566.

    Article  PubMed  CAS  Google Scholar 

  21. Lance JW, Anthony M: Migrainous neuralgia or cluster headache. J Neurol Sci 1971, 13:401–414.

    Article  PubMed  CAS  Google Scholar 

  22. Blau JN: Behavior during a cluster headache. Lancet 1993, 342:723–725.

    Article  PubMed  CAS  Google Scholar 

  23. van Vliet JA, Eekers PJ, Haan J, Ferrari MD: Features involved in the diagnostic delay of cluster headache. J Neurol Neurosurg Psychiatry 2003, 74:1123–1125. This survey highlights the diagnostic dilemmas involved in establishing a diagnosis of cluster headache and provides several features that may potentiate this problem.

    Article  PubMed  Google Scholar 

  24. Rozen TD: Atypical presentations of cluster headache. Cephalalgia 2002, 22:725–729.

    Article  PubMed  CAS  Google Scholar 

  25. Nappi G, Micieli G, Cavallini A, et al.: Accompanying symptoms of cluster attacks: their relevance to the diagnostic criteria. Cephalalgia 1992, 12:165–168.

    Article  PubMed  CAS  Google Scholar 

  26. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome, and other short-lasting headaches with autonomic features, including new cases. Brain 1997, 120:193–209. Well-written and thorough review of the trigeminal-autonomic cephalgias.

    Article  PubMed  Google Scholar 

  27. Silberstein SD, Lipton RB, Goadsby PJ: Headache in Clinical Practice. London: Martin Dunitz Ltd; 2002.

    Google Scholar 

  28. Bigal ME, Rapoport AM, Camel M: Cluster headache as a manifestation of intracranial inflammatory myofibroblastic tumour: a case report with pathophysiological considerations. Cephalalgia 2003, 23:124–128.

    Article  PubMed  CAS  Google Scholar 

  29. Rahmann A, Husstedt IW, Evers S: Cluster headache after removal of a subarachnoid cyst: a case report. Headache 2003, 43:130–131.

    Article  PubMed  Google Scholar 

  30. Lee MS, Lessell S: Orbital myositis posing as cluster headache. Headache 2003, 43:429.

    Article  Google Scholar 

  31. Piovesan EJ, Lange MC, Werneck LC, et al.: Cluster-like headache: a case secondary to the subclavian steal phenomenon. Headache 2001, 21:850–851.

    CAS  Google Scholar 

  32. Soros P, Frese A, Husstedt IW, Evers S: Cluster headache after dental extraction: implications for the pathogenesis of cluster headache? Headache 2001, 21:619–622.

    CAS  Google Scholar 

  33. Penarrochoa M, Bagan JV, Penarrocha MA, Silvestre FJ: Cluster headache and cocaine use. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000, 90:271–274.

    Article  Google Scholar 

  34. Leandri M, Cruccu G, Gottlieb A: Cluster headache-like pain in multiple sclerosis. Cephalalgia 1999, 19:732–734.

    Article  PubMed  CAS  Google Scholar 

  35. Ekbom K: Treatment of acute cluster headache with sumatriptan. N Engl J Med 1991, 325:322–326.

    Article  Google Scholar 

  36. Ekbom K, Cole JA: Subcutaneous sumatriptan in the acute treatment of cluster headache attacks. Can J Neurol Sci 1993, 20:30.

    Google Scholar 

  37. Ekbom K, Krabbe A, Micieli G, et al.: Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Sumatriptan Long-Term Study Group. Cephalalgia 1995, 15:230–236.

    Article  PubMed  CAS  Google Scholar 

  38. Gobel H, Lindner V, Heinze A, et al.: Acute therapy for cluster headache with sumatriptan: findings of a 1-year long-term study. Neurology 1998, 51:908–911.

    PubMed  CAS  Google Scholar 

  39. Hardebo JE, Dahlof C: Sumatriptan nasal spray (20 mg/dose) in the acute treatment of cluster headache. Cephalalgia 1998, 18:487–489.

    Article  PubMed  CAS  Google Scholar 

  40. Schuh-Hofer S, Reuter U, Kinze S, et al.: Treatment of acute cluster headache with 20 mg sumatriptan nasal spray: an open pilot study. J Neurol 2002, 249:94–99.

    Article  PubMed  CAS  Google Scholar 

  41. van Vliet JA, Bahra A, Martin V, et al.: Intranasal sumatriptan in cluster headache: randomized placebo-controlled doubleblind study. Neurology 2003, 60:630–633.

    Article  PubMed  Google Scholar 

  42. Monstad I, Krabbe A, Micieli G, et al.: Preemptive oral treatment with sumatriptan during a cluster period. Headache 1995, 35:607–613.

    Article  PubMed  CAS  Google Scholar 

  43. Bahra A, Gawel MJ, Hardebo JE, et al.: Oral zolmitriptan is effective in the acute treatment of cluster headache. Neurology 2000, 54:1832–1839.

    PubMed  CAS  Google Scholar 

  44. Fogan L: Treatment of cluster headache: a double-blind comparison of oxygen v air inhalation. Arch Neurol 1985, 42:362–363.

    PubMed  CAS  Google Scholar 

  45. Kudrow L: Response of cluster headache attacks to oxygen inhalation. Headache 1981, 21:1–4.

    Article  PubMed  CAS  Google Scholar 

  46. Igarashi H, Sakai F, Tazaki Y: The mechanism by which oxygen interrupts cluster headache. Cephalalgia 1991, 11(suppl 11):238–239.

    Google Scholar 

  47. Andersson PG, Jespersen LT: Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. Cephalalgia 1986, 6:51–54.

    Article  PubMed  CAS  Google Scholar 

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Grosberg, B.M., Solomon, S. Recognition and treatment of cluster headache in the emergency department. Current Science Inc 8, 140–146 (2004). https://doi.org/10.1007/s11916-004-0028-6

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  • DOI: https://doi.org/10.1007/s11916-004-0028-6

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