CLUSTER HA = HORTON’S HISTAMINIC CEPHALALGIA = SUICIDE HA

ERYTHROCEPHALALGIA, ERYTHROPROSOPALGIA, NASOCILIARY NEURALGIA

NOT A MIGRAINE VARIANT—-CAN DIFF FROM HEMIFACIAL MIGRAINE VIA HIGH CIP (DYNAMIC TONOMETRY)

NO AURA

?A RHINOPATHIC HA—-SP GANGLION DYSFUNCTION?—MUST DIFF FROM SLUDER’S LOWER HALF HA (VAIL’S OR VIDIAN’S NEURALGIA) AND RAEDER’S SYNDROME (INCOMPLETE HORNER’S)

SUDDEN, EXPLOSIVE, PAROXYSMAL ONSET

SHORT DURATION(MINUTES-HOURS)15 MIN TO 180 MIN

VERY SEVERE (“POKER IN THE EYE”, UNILAT, RETRO-ORBITAL PAIN (SUICIDE HA)

OFTEN WORSE WITH HEAD DEPENDENT

FEQUENTLY MISDIGNOSED AS ACUTE RHINOSINUSITIS

SCLERAL INJECTION

LACRIMATION—EPIPHORA

CLEAR RHINORRHEA—CONGESTION–NAO (DIFF ACUTE RHINOSINUSITIS–LASTS ONLY MINUTES TO HOURS)

PERSPIRATION (OPPOSITE HORNERS)

MIOSIS AND PTOSIS

EYELID EDEMA

MALE >90% (ONLY HA WITH A MALE PREDOMINANCE)

NO SIG Fhx

ONSET 2ND TO 5TH DECADE

ETOH COMMON

USUALLY ONE SIDE IS DOMINANT

WORSE WHEN LAYING DOWN

N/V ARE VERY RARELY ASSOC.

NO AURA–NO SONO OR PHOTOPHOBIA

ALMOST ALWAYS < 2 HOURS

SEASONAL (FALL/SPRING PREPONDERANCE—OFTEN A “CLUSTER” OF HA’S WHICH LASTS WEEKS TO MONTHS

ALLERGY AS A CONTRIBUTING ETIOLOGY?

Rx:

4% TOPICAL LIDOCAINE DROPS INTO IPSI NOSTRIL—-15 MIN HIGH RELIEF

100% O2

INDOCIN

PREDNISONE

ANTIHISTAMINES

DHE (ERGOTOMINES)/METHYSERGIDE(SANSERT)–RP FIBROSIS IS RARE AND DOSE DEP.