Primary headache syndromes characterized by severe short-lasting headaches accompanied by paroxysmal facial autonomic symptoms
Clinical presentation
Headache
Autonomic features include: ptosis, miosis, nasal stuffiness, nausea/vomiting, tearing, eye lid oedema
Investigations
Those with new onset unilateral cranial autonomic features require imaging - MRI brain and MR angiogram
Cluster headache
More common in 30s-40s, more common in men
Clinical features
Recurrent attacks of sudden-onset unilateral periorbital pain, associated with a watery and bloodshot eye, lacrimation, rhinorrhoea, miosis, ptosis, lid swelling, and facial flushing
Headaches last 15 minutes to 3 hours, occur once or twice a day, over a period of 4-12 weeks, and are followed by a pain-free period of months before the next cluster begins
Management
Acute attack: high flow O2 100% for 20 mins with a subcutaneous or nasal triptan, steroids (reducing course over 2 weeks)
Prophylaxis: verapamil
Paroxysmal hemicrania
More common in 50s-60s, more common in women
Clinical features
Severe unilateral headache
Unilateral autonomic features
10-30 mins duration
1-40 a day
Management
Absolute response to indomethicin
Hemicrania continua
More common in 50s-60s, more common in women
Clinical features
Severe unilateral headache
Unilateral autonomic features
Constant duration
Management
Absolute response to indomethicin
SUNCT
Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
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