Treatment of Cluster Headache

Case: 29 year old male presents with new onset gradually worsening pain located behind R eye. Associated sweating and Nasal Congestion.

Tapa: When working up headaches, the H&P can help separate out the benign from the concerning.

Concerning signs & symptoms include:

• Fever, Meningeal signs, Photophobia, AMS, Syncope, Sudden Onset/Worst HA of life, Trauma, HTN with DBP > 120, unilateral neck pain, signs of glaucoma, or neuro deficits

In this case, the patient has some classic presenting symptoms of a Cluster Headache. Although Cluster Headaches typically present in men in their 40s, they have been reported in both infants and the elderly. Classic signs & symptoms include sudden onset unilateral pain behind the orbit with associated lacrimation.

If you suspect a Cluster Headache, start the patient on Oxygen before presenting the case. The risks and expense of giving oxygen are relatively low. By starting the patient on O2 you will potentially decrease the time of their ED stay (not to mention you will impress your attending/resident)!

If the Headache resolves with oxygen, this is sufficient for diagnosis of a cluster headache. The patient should follow up with a neurologist as an outpatient. If the symptoms do not resolve, consider other therapeutic medications, or consider re-addressing your differential diagnosis.