The other primary headache disorder
that we see in the Emergency Department are cluster headaches.
Cluster headaches are more common in men than in women
and they occur over a period of time.
So they occur over a period of days to weeks
and can be brought on by alcohol use, stress,
as well as climate changes.
This is a sudden onset, unilateral headache.
Oftentimes, patients describe it as being behind one of their eyes
and the headache generally lasts between 15 minutes to about three hours in length of time.
Patients who present with cluster headaches are generally very, very uncomfortable.
This is a severe painful, painful headache.
They may be agitated, they may be rubbing their head,
and they may also have ipsilateral ptosis,
so drooping of the eyelid, miosis, so a constricted pupil,
as well as nasal congestion on that side,
tearing and injection of the eye.
So the eye might look very red.
So when someone comes in with these symptoms,
we definitely wanna make sure we’re thinking about a cluster headache
and the most common thing
that points us in the direction of diagnosing a cluster headache
is someone having a history of cluster headaches.
So they come in and they say,
“I’ve had this a handful of times before.”
And they may know that it’s called a cluster headache or they might not,
but a history of similar is something that definitely should point you in this direction.
Now, you wanna consider getting some kind of neuroimaging
to rule out a space occupying lesion if a patient has no prior history.
So if they come in saying they’ve never experienced this before,
you can imagine that if your patient is very uncomfortable and in severe pain,
they may require additional workup if you’re thinking about this problem.
The management for cluster headaches is actually quite interesting.
The treatment is relatively simple
and involves placing your patient on a high flow non-rebreather mask of oxygen.
This is actually effective in approximately 80% of patients
presenting with cluster headaches
and is a very easy and quick thing that can be done.
Sumatriptan is another medication that has been shown to be of some benefit.
And lastly, steroids such as prednisone can break the cycle of the cluster headache.
So it should be prescribed to a patient as well to prevent them from getting future headaches.