Epidemiology and Aetiology
- 10-50x less common than migraine
- M:F – 5:1
- Often disappear after the age of 55
- Patients are often smokers with a high alcohol intake, although there are no proven aetiological factors, and no genetic links
- Episodic, Intense, unilateral pain – usually around one eye, increasing in intensity over 30-60 minutes, and then lasting anywhere between 30-90 minutes.
- Typically, episodes occur grouped together – e.g. several in one week, then nor more attack for several months.
- Can have 2 or more attack in one day
- In some patients it is chronic, and there are no periods without attacks
- Usually occurs in the early hours of the morning
- Unilateral lacrimation, rhinorrhoea (runny nose) and post-nasal drip. Eye may be become bloodshot, and the lid may swell.
- Miosis and ptosis can occur, and in 5% of cases this can be permanent.
- Vomiting is unusual
- Feeling of congestion of the sinuses unilaterally
- Transient ipsilateral Horner’s Syndrome
- At least 5 attacks
- Sudden onset, unilateral headache
- Orbital or retro-orbital
- Lasting 15min – 3 hours
- At least 2 of
- Associated rhinorrhoea
- Eyelid oedema
- Facial swelling
- Ipsilateral (same side) conjunctival redness or excessive lacrimation (tears)
- Forehead or facial swelling or flushing
- Miosis or ptosis
- Occur between once every 2 days and 8 times daily
If headache is new – consider CT – sudden onset headaches are often more clinically significant than gradual onset and chronic headaches
- 100% oxygen – use a non-rebreathing mask at 7-15L for around 15 minutes
- Subcutaneous sumatriptan – 6mg at onset of attack
- Verapamil – 80-120mg every 8 hours
- Corticosteroids – short courses – consider prednisolone 50mg/day for 10 days, followed by a sort taper before cessation
- Methysergide – 4-10mg/day for up to 3 months
- Sodium valproate
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy