Acute Headache: Hypertensive Urgency and Cluster Headache (Horton's Syndrome)

by Carlo Raj, MD

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    Let’s talk about hypertensive urgency as being a presentation of acute headache. Dull, bilateral ache head pain, no focal deficit, possible diminished level of consciousness if associated with reversible posterior type of leukoencephalopathy. Usually seen when systolic blood pressure is above 170 and the diastolic blood pressure is above 110. Treatment here is you need to make sure that you take care of the hypertension. Urgency versus your crisis, or emergency, and your crisis is the one in which you don’t mess around. At that point, you need to make sure that you give IV, do everything in power in which you give IV nitroprusside to take care of the blood pressure ASAP. Remember, we talked about hypertension urgency versus crisis. Here, let’s talk about a cluster headache. The duration becomes important. Abrupt in onset, peaking approximately five to ten minutes later. That is important. Pay attention to that. Persists for 45 minutes to 2 hours. And clusters, meaning to say over days to weeks. So it comes in these clusters, over days to weeks. Peak of five to ten, persists for 45 minutes to 2 hours, and comes in clusters. Consistently unilateral and orbital in location. “Doc, it feels like I have pain in my eye. It feels like someone is stabbing me in the eye.” Orbital location. Pain described is deep, intense, boring, meaning to say like a needle being put. So, they don’t call this being throbbing. Throbbing will refer to as being our giant cell arteritis. “Doc, I feel like these pulsations of throbbing headaches.” Boring is more like a needle, being stabbed. These patients are moving around the room, banging their head on the wall, screaming for medication because could you imagine putting a needle into your eye? Isn’t a good feeling. Nausea and vomiting...

    About the Lecture

    The lecture Acute Headache: Hypertensive Urgency and Cluster Headache (Horton's Syndrome) by Carlo Raj, MD is from the course Headache. It contains the following chapters:

    • Acute Headache: Hypertensive Urgency
    • Acute Headache: Cluster Headache

    Included Quiz Questions

    1. Treat with IV nitroprusside
    2. Treat with aspirin
    3. Massage the head
    4. Treat with IM nitroprusside
    5. Treat with sublingual nitroprusside
    1. IV nitroprusside
    2. Intranasal lidocaine
    3. Dihydroergotamine subcutaneous
    4. Sumatriptan Subcutaneous
    5. Face mask oxygen
    1. A cluster headache is typically unilateral and orbital in location.
    2. Confirmatory diagnosis of this headache is by bilateral carotid angiography.
    3. A cluster headache is throbbing in nature.
    4. Lithium is useful in the treatment of the headaches.
    5. Females often present with such headaches.

    Author of lecture Acute Headache: Hypertensive Urgency and Cluster Headache (Horton's Syndrome)

     Carlo Raj, MD

    Carlo Raj, MD

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