🎯 Pathology

• excruciating, recurrent unilateral headaches

• patients may report the pain being “10 out of 10”

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💡 Causes​

• may be linked to the activity of the hypothalamus and linked to the circadian rhythm, which explains why the attacks tend to occur at night

• risk factors

  • male

  • alcohol

  • family history

  • smoking

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🩺 Clinical features

• timing

  • occur in clusters (persist for up to 12 weeks)

  • each episode may last between 15 minutes to 3 hours

  • attacks tend to happen at night

  • can occur up to eight times a day

• intense unilateral pain concentrated around the eye

• agitation

• autonomic symptoms

  • increased lacrimation

  • redness of the eye

  • miosis and/or ptosis

  • rhinorrhoea and nasal congestion

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🕵️‍♂️ Investigations

• clinical diagnosis

• neuroimaging

  • best: MRI with contrast to rule out structural abnormalities

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💆‍♂️ Management

• initial

  • 100% oxygen (the effect is seen within 10 minutes)

  • subcutaneous or intranasal sumatriptan

• long-term

  • verapamil

  • glucocorticoids may also be considered