Saturday, 11 September 2010

MRCP revision battle 8.1: Cluster headache

Its Saturday and sunny so I'm not particularly feeling the MRCP revision love.  But the battle must continue, and today's topics are:

Revision battle 8.1: Cluster headache
Revision battle 8.2: Arsenic poisoning
Revision battle 8.3: Mee's lines
Revision battle 8.4: Reversible causes of cardiac arrest
Revision battle 8.5 Pituitary tumours
Revision battle 8.6: Romano-Ward and Jervell-Lange-Nielson

Revision battle 8.1: Cluster headache

Cluster headaches appear in the MRCP exam (and occasionally real life) as:
  • severe unilateral pain focused around one eye with
  • redness of the eye and possibly
  • lid swelling with
  • lacrimation and
  • nasal congestion
It is worth noting that up to 20% will also get ptosis, which in a minority of cases can be permanent.

Cluster headaches are more common in males (5:1).
Risk of suffering from cluster headache is increased if you are a smoker.

Classically patients will suffer from severe 15 minute to 2 hour bouts of pain once or twice a day over a period of 4 to 12 weeks.

Treatment acutely is 100% oxygen.  S/C sumitriptan and nasal lidocaine are also proposed as treatments.

Prophylactic options include verapamil, prednisolone or lithium.

So onwards to a slightly curveball topic - arsenic poisoning...