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 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.
- Feeling of congestion of the sinuses unilaterally
- Transient ipsilateral Horner’s Syndrome
- 100% oxygen – use a non-rebreathing mask at 7-15L for around 15 minutes
- Subcutaneous sumatriptan – mg at onsent of attack
- Verapamil – 80-120mg every 8 hours
- Corticosteroids – short courses
- Methysergide – 4-10mg/day for up to 3 months