Cluster headache (Migrainous neuralgia, Horton’s neuralgia)

Epidemiology:

• Peak age 30s-40s
• Men > women

Clinical features:

• Recurrent bouts of excruciating pain that wake the patient at night and are centred around one eye
• Can be precipitated by alcohol
• Pain rises to a crescendo over ~30 minutes and lasts for several hours
• Vomiting occurs
• One side of the face and nostril feel congested
• A transient ipsilateral Horner’s syndrome is common during the attack

Management:

• Despite the very severe pain, there are no serious sequelae
• Attacks recur at intervals over several years but tend to disappear over the age of 55 years
• Analgesics during the attack are NOT effective

Prophylaxis:

• Lithium carbonate (400-1200mg daily)
• Inhalation of oxygen can help abort an attack