Скачать или смотреть Neuro: Cluster Headaches: Free MSRA Podcast

💥 FREE MSRA PODCAST – Cluster Headache: The ‘Suicide Headache’ Explained


🎧 Unpack the most excruciating primary headache in medicine: high-yield facts, pitfalls, and how to get the diagnosis and management right first time.


🧠 Key Learning Points


📌 Definition
• Cluster headache = severe, unilateral (one-sided) headache disorder
• Attacks occur in “clusters”: frequent bouts (1–8 per day), lasting 15–180 mins, for weeks–months, with pain-free remissions
• Nicknamed the “suicide headache” due to intensity


📌 Causes & Risk Factors
• Thought to involve hypothalamic dysfunction (body clock), trigeminal nerve activation, neurovascular changes
• Risk factors: Male (3–4:1), age 20–50, family history, smokers, alcohol triggers attacks (esp. during cluster periods)


📌 Pathophysiology
• Dysfunction in hypothalamus (circadian rhythm) → activates trigeminal–autonomic reflex
• Causes release of neuropeptides → vasodilation, neuroinflammation
• Pain & autonomic symptoms occur on the same side as the headache


📌 Symptoms
• Sudden, severe, unilateral orbital/temporal pain
• Associated ipsilateral autonomic features:
 – Red, watery eye (conjunctival injection, lacrimation)
 – Nasal congestion/rhinorrhoea
 – Ptosis (droopy eyelid), miosis (small pupil)
 – Forehead/facial sweating
• Patients are restless/agitated (pacing/rocking, not lying still like migraine)
• Attacks at same time daily (“alarm clock headache”)


📌 Diagnosis
• Clinical diagnosis: ≥5 attacks, 15–180 mins, severe unilateral orbital/supraorbital/temporal pain, with ≥1 autonomic sign or restlessness
• Frequency: 1 every other day to 8/day
• Rule out other causes (MRI if red flags or atypical features)


📌 Differential Diagnosis
• Migraine, paroxysmal hemicrania, SUNCT, tension-type headache, sinusitis, TMJ dysfunction


📌 Management
• Acute:
 – High-flow O₂ (12–15 L/min via non-rebreather mask)
 – Subcutaneous sumatriptan (75% effective within 15 mins)
 – Nasal triptan or intranasal lidocaine (adjunct)
• Preventive:
 – Verapamil (first line, needs ECG monitoring)
 – Alternatives: lithium, prednisolone, topiramate
• Avoid triggers (esp. alcohol), refer to neurology, support groups/counselling


📌 Complications
• Severe impact on quality of life (sleep, work, mood, relationships)
• Risk of depression, suicidal ideation
• Medication side effects (verapamil, lithium, triptans)
• Chronic form may develop (10–20%), resistant cases possible


📌 Prognosis
• Most have episodic CH (80–90%) with long remissions
• Chronic in 15–20%; ~10–20% of these may not respond to standard treatment
• Many improve with age, longer remission periods; some “burn out” after ~15 years


📎 More MSRA Resources for Cluster Headache:
📝 Revision Notes: https://www.passthemsra.com/topic/cluster-...
🧠 Flashcards: https://www.passthemsra.com/topic/cluster-...
💬 Accordion Q&A: https://www.passthemsra.com/topic/cluster-...
🚀 Rapid Quiz: https://www.passthemsra.com/topic/cluster-...
🎓 Neurology Course: https://www.passthemsra.com/courses/neurol...


#ClusterHeadache #SuicideHeadache #MSRARevision #NeurologyMSRA #MSRAFlashcards #MSRAQuiz #PassTheMSRA #MSRAPodcast #PrimaryHeadache #Verapamil #Sumatriptan #HighFlowOxygen #TrigeminalCephalalgia #AlarmClockHeadache