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Cluster Headache Cluster headache • History: • Occurs in clusters • several assaults a day for weeks / months, • then remission • Strictly unilateral • Excruciatingly extreme, frontal / retro-orbital • Attacks shorter than migraine • 30 min – 4 hours • Up to eight occasions a day • Ultradian rhythms (extra typically at night) • Patients are stressed (cf migraine) • Trigeminal autonomic features • Ptosis, tearing, conjunctival injection, flushing, rhinorrhea Cluster headache • Acute treatment: • High move O2 – aborts most assaults • a hundred% by way of non-rebreathe mask • Sc sumatriptan 6mg • Nasal triptans may work (much less efficient) • Oral triptans do not work • Prevention: • High dose prednisolone at cluster onset, tapering • Greater Occipital Nerve Block at start of a cluster • Start Verapamil (or Lithium / Topiramate) Other primary complications • Occasional extreme transient stabs. Can M ed Assoc J 1970; 102:263 268 RefIncl= In Ref= Includederence List, however not specifically inclexcluded= Excluded Williams 2003 – ” Abes 2003 – “A Thanaviratananich Wall2009 Takata 2001 – Bonati 1992 Leach 2006 – M cDonald 2008 – Straetemans 2004 – Use ofantibiotics in systematic evaluation of 2008 – “Once or “Ciprofloxacin Damoiseaux 1998 – G lasziou 2004 – Kozyrskyj2000 – Rosenfeld 1994 – Rovers 2006 – Spurling 2007 – “Evidence “M etaanalysis of “Antibiotics for the “G rommets “Pnemococcal preventing recurrent the effectiveness of twice daiily versus zero chronic gastritis meaning purchase allopurinol without a prescription. The subsequent factor on the agenda is the new drugs to market, but I dont have anything right now. The action of gravity would naturally pull the weight downwards, shifting the elbow into extension from the flexed place. 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