Cluster Headache
| A | Headache is predominantly unilateral | |
| B |
Affects predominantly females |
|
| C |
Onset typically occur in 20-50 years of life |
|
| D |
Associated with conjunctival congestion |
Which of the following is not a feature of cluster headache ?
| A |
Headache is predominantly unilateral |
|
| B |
Affects predominantly females |
|
| C |
Onset typically occur in 20-50 years of life |
|
| D |
Associated with conjunctival congestion |
A young girl presents with repeated episodes of throbbing occipital headache associated with ataxia and vertigo. The family history is positive for similar headaches in her mother. Most likely diagnosis is:
| A |
Vestibular Neuronitis |
|
| B |
Basilar migraine |
|
| C |
Cluster headache |
|
| D |
Tension headache |
It mainly occurs in young females and children, frequently in context with a family history of other forms of migraine.
It clinically manifests with bilateral visual symptoms associated with vertigo, ataxia, tinnitus.
Weakness and peripheral dysaesthesias and sometimes other brainstem and occipital lobe symptoms.
This is followed by severe, throbbing, posterior bilateral headache.
Ref: Benign childhood partial seizures and related epileptic syndromes — Chrysostomos P. Panayiotopoulos, Page 304
MIDAS questionnaire is used to assess the extent and disability in which of the following conditions?
| A |
Migraine |
|
| B |
Myasthenia Gravis |
|
| C |
Temporal arteritis |
|
| D |
Cluster headache |
MIDAS is Migraine Disability Assessment Score.
It is used to assess the extend and disability associated with migraine.
A 45-year old man presents with a daily headache. He describes two attacks per day over the past 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. The patient has noted associated tearing and reddening of his right eye as well as nasal stuffiness. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is nonfocal. The most likely diagnosis of this patient’s headache is :
| A |
Migraine headache |
|
| B |
Cluster headache |
|
| C |
Tension headache |
|
| D |
Brain tumour |
The answer is B (Cluster headache):
Cluster Headache
- Lateralized, periorbital or less commonly temporal
- All ages above 10 yrs with a peak of 30-50 yrs
- Male preponderance (90%). Men affected 7-8 times more than females.
- Hereditary factors usually absent
- Presentation: Pain (periodic attacks 1-2/day) begins without warning reaches crescendo within 5 minutes lasts for 45 minutes, excruciating, deep, explosive pain but only rarely pulsatile
– commonly awakens the patients from sleep
Associated symptoms :
These are typical and characteristic :
– homolateral lacrimation
– reddening of eye nasal stuffiness
– Ptosis and
– nausea
Migraine
- Lateralized, usually frontotemporal may be generalized
- All age groups are affected
- Females are affected more than males
- Family history present
- Presentation: Pain
often preceded by an aura
builds up gradually
– may last for several hours or longer
– usually throbbing but maybe dull
– onset is after awakening & quietened by sleep
Associated symptoms include :
– nausea, vomiting, diarrhea
photophobia and visual disturbance in the form of photopsia and fortification spectra paraesthesias with tingling and numbness other focal neurological symptoms such as clumsiness and weakness.
| A | Migraine | |
| B |
Cluster headache |
|
| C |
Tension headache |
|
| D |
Trigeminal neuralgia |
Ans. C. Tension headache
Tension-type headache is a generalized headache that occurs in patients subjected to stress anxiety and depression.
More so the symptomatology of cluster headache, migraine, and trigeminal neuralgia is quite distinct from that mentioned above.
Tension Headache :
- It is a chronic head pain syndrome characterized by a tight band like discomfort.
- Headaches are usually generalized may be most intense about the neck or back of the head.
- Patients frequently complain of poor concentration and other vague nonspecific symptoms.
- Maybe exacerbated by emotional stress, fatigue, noise or glare.
- It is not associated with focal neurological symptoms.
| A | Temporal arteritis | |
| B |
Migraine |
|
| C |
Cluster headache |
|
| D |
Sinusitis |
Answer is A (Temporal Arteritis):
The symptom and the laboratory examination of the patients almost confirms the diagnosis of temporal arteritis.
In an elderly patient who presents with headache, visual symptoms (blindness), malaise, fever, weakness with or without pain or tenderness over temporal artery (thick cord like structure) and a raised ESR, it is definitively suggestive of Temporal arteritis
A 35 year old Lady Malti has unilateral headache, nausea, vomiting and visual blurring. The diagnosis is
| A |
Cluster headache |
|
| B |
Glaucoma |
|
| C |
Subarachnoid haemorrhage |
|
| D |
Posterior fossa cyst. |
Answer is B (Glaucoma):
Presence of visual blurring and female sex suggest a diagnosis of glaucoma over cluster headache amongst the options provided.
Differential diagnosis are :
Female patient (Glaucoma is about four times more common in females while 80% of patients with cluster headache are males)
Visual blurring (Visual blurring is a feature of Glaucoma. Cluster headache has ocular features mainly limited to reddening of eye and homolateral lacrimation but vision has not been mentioned as being affected).
| A |
Vestibular Neuronitis |
|
| B |
Basilar migraine |
|
| C |
Cluster headache |
|
| D |
Tension headache |
Ans.B. Basilar migraine
Repeated episodes of throbbing occipital headache in association with ataxia and vertigo in a young female with a positive family history of headache suggest a diagnosis of basilar migraine.
Dizziness, vertigo, and ataxia heralding an intense throbbing (occipital) headache are typical features of basilar type migraine.
Diagnosis of Basilar Migraine is suggested by age, female gender, positive family history and attacks of headache with vertiginous aura provoked by usual migraine triggers
Basilar Type Migraine (a subtype of migraine with aura).
- Basilar type migraine describes recurrent attacks of migraine with aura in which symptoms suggest a brainstem origin (including vertigo & ataxia)
- The onset of Basilar type migraine is typically before 30 years of age and peaks during adolescence.
- There is a distinct female preponderance with girls more frequently affected than boys in a ratio of 3:1 (the majority of sufferers are girls )
- Family history of migraine is frequent.
- Unlike other types of migraine headache may be occipital in origin.
| A | Most common in male | |
| B |
Periorbital in location |
|
| C |
Bilateral |
|
| D |
Symptoms seen in early hours of the morning |
Ans: C i.e. Bilateral
Cluster headache
- Cluster headache shows a 5:1 predominance of males and onset is usually in the third decade
- The characteristic presentation of cluster headache is with periodic, severe, unilateral periorbital pain accompanied by unilateral lacrimation, nasal congestion and conjunctival injection, often with other features of Horner’s syndrome
- Typically, the patient develops these symptoms at a particular time of day (often in the early hours of the morning)
