Current Pain and Headache Reports

, Volume 5, Issue 1, pp 83–91 | Cite as

Treatment and management of cluster headache

  • David W. Dodick
  • David J. Capobianco
Article

Abstract

Cluster headache is an uncommon yet well-defined neurovascular syndrome occurring in both episodic and chronic varieties. The most striking feature of cluster headache is the unmistakable circadian and circannual periodicity. Inheritance may play a role in some families. The attacks are of extreme intensity, of short duration, occur unilaterally, and are accompanied by signs and symptoms of autonomic dysfunction. In contrast to migraine, during an attack the cluster patient prefers to pace about. Attacks frequently occur at night.

Although the pathophysiology of cluster headache remains to be fully elucidated, several seminal observations have recently been made. The medical treatment of cluster headache includes both acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period. Agents used for acute therapy include inhalation of oxygen, sumatriptan, and dihydroergotamine. Transitional prophylaxis involves the short-term use of either corticosteroids or ergotamine derivatives. The cornerstone of maintenance prophylaxis is verapamil, yet methysergide, lithium, and divalproex sodium may also be employed. In some patients, melatonin or topiramate may be useful adjunctive therapies.

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References and Recommended Reading

  1. 1.
    Harris W: Ciliary (migrainous) neuralgia and its treatment. BMJ 1936, 1:457–460.PubMedGoogle Scholar
  2. 2.
    Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8:1–96.CrossRefGoogle Scholar
  3. 3.
    Ekbom K, Ahlborg B, Schele R: Prevalence of migraine and cluster headache in Swedish men of 18. Headache 1978, 18:9–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Kudrow L: Cluster Headache: Mechanisms and Management. Oxford; New York: Oxford University Press; 1980.Google Scholar
  5. 5.
    D’Alessandro R, Gamberini G, Benassi G, et al.: Cluster headache in the Republic of San Marino. Cephalalgia 1986, 6:159–162.PubMedCrossRefGoogle Scholar
  6. 6.
    Swanson JW, Yanagihara T, Stang PE, et al.: Incidence of cluster headaches: a population-based study in Olmsted County, Minnesota. Neurology 1994, 44:433–437.PubMedGoogle Scholar
  7. 7.
    Horton B: Histaminic cephalgia. Differential diagnosis and treatment: 1176 patients 1932–1955. Proc Staff Meet Mayo Clin 1956, 31:325–333.PubMedGoogle Scholar
  8. 8.
    Lovshin L: Clinical caprices of histaminic cephalgia. Headache 1961, 1:3–6.Google Scholar
  9. 9.
    Manzoni GC: Male preponderance of cluster headache is progressively decreasing over the years. Headache 1997, 37:588–589.PubMedCrossRefGoogle Scholar
  10. 10.
    Manzoni GC: Gender ratio of cluster headache over the years: a possible role of changes in lifestyle. Cephalalgia 1998, 18:138–142.PubMedCrossRefGoogle Scholar
  11. 11.
    Moskowitz MA: Cluster headache: evidence for a pathophysiologic focus in the superior pericarotid cavernous sinus plexus. Headache 1988, 28:584–586.PubMedCrossRefGoogle Scholar
  12. 12.
    Hardebo JE: How cluster headache is explained as an intracavernous inflammatory process lesioning sympathetic fibers. Headache 1994, 34:125–131.PubMedCrossRefGoogle Scholar
  13. 13.
    Goadsby PJ: Cluster headache: new perspectives. Cephalalgia 1999, 19(suppl 25):39–41.PubMedGoogle Scholar
  14. 14.
    Ekbom K, Greitz T: Carotid angiography in cluster headache. Acta Radiol Diagn (Stockh) 1970, 10:177–186.Google Scholar
  15. 15.
    Waldenlind E, Ekbom K, Torhall J: MR-angiography during spontaneous attacks of cluster headache: a case report. Headache 1993, 33:291–295.PubMedCrossRefGoogle Scholar
  16. 16.
    May A, Kaube H, Buchel C, et al.: Experimental cranial pain elicited by capsaicin: a PET study. Pain 1998, 74:61–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Kudrow L: Plasma testosterone levels in cluster headache preliminary results. Headache 1976, 16:28–31.PubMedCrossRefGoogle Scholar
  18. 18.
    Leone M, Patruno G, Vescovi A, Bussone G: Neuroendocrine dysfunction in cluster headache. Cephalalgia 1990, 10:235–239.PubMedCrossRefGoogle Scholar
  19. 19.
    Brzezinski A: Melatonin in humans. N Engl J Med 1997, 336:186–195.PubMedCrossRefGoogle Scholar
  20. 20.
    Hofman MA, Zhou JN, Swaab DF: Suprachiasmatic nucleus of the human brain: an immunocytochemical and morphometric analysis. Anat Rec 1996, 244:552–562.PubMedCrossRefGoogle Scholar
  21. 21.
    Waldenlind E, Gustafsson SA, Ekbom K, Wetterberg L: Circadian secretion of cortisol and melatonin in cluster headache during active cluster periods and remission. J Neurol Neurosurg Psychiatry 1987, 50:207–213.PubMedGoogle Scholar
  22. 22.
    May A, Bahra A, Buchel C, et al.: Hypothalamic activation in cluster headache attacks. Lancet 1998, 352:275–278. A landmark study demonstrating, for the first time, activation of the hypothalamus during attacks of cluster headache, illustrating a possible generator for this disorder.PubMedCrossRefGoogle Scholar
  23. 23.
    May A, Bahra A, Buchel C, et al.: Functional magnetic resonance imaging in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing. Ann Neurol 1999, 46:787–790.CrossRefGoogle Scholar
  24. 24.
    May A, Ashburner J, Buchel C, et al.: Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999, 5:836–838. Important study demonstrating asymmetry in the hypothalamus ipsilateral to the patients’ attacks, and suggesting for the first time that primary headache disorders may be associated with abnormal brain structure as well as brain function.PubMedCrossRefGoogle Scholar
  25. 25.
    Russell MB: Genetic epidemiology of migraine and cluster headache. Cephalalgia 1997, 17:683–701. A lucid, in-depth, and insightful review of the genetic underpinnings of cluster headache.PubMedCrossRefGoogle Scholar
  26. 26.
    Couturier EG, Hering R, Steiner TJ: The first report of cluster headache in identical twins. Neurology 1991, 41:761.PubMedGoogle Scholar
  27. 27.
    Roberge C, Bouchard JP, Simard D, Gagne R: Cluster headache in twins. Neurology 1992, 42:1255–1256.PubMedGoogle Scholar
  28. 28.
    Sjaastad O, Shen JM, Stovner LJ, Elsas T: Cluster headache in identical twins. Headache 1993, 33:214–217.PubMedCrossRefGoogle Scholar
  29. 29.
    Russell MB, Andersson PG, Thomsen LL, Iselius L: Cluster headache is an autosomal dominantly inherited disorder in some families: a complex segregation analysis. J Med Genet 1995, 32:954–956.PubMedCrossRefGoogle Scholar
  30. 30.
    Russell MB, Andersson PG, Iselius L: Cluster headache is an inherited disorder in some families. Headache 1996, 36:608–612.PubMedCrossRefGoogle Scholar
  31. 31.
    Ekbom K: A clinical comparison of cluster headache and migraine. Acta Neurol Scand 1970, 46(suppl 1):1–10.Google Scholar
  32. 32.
    Kudrow L, Kudrow DB: Association of sustained oxyhemoglobin desaturation and onset of cluster headache attacks. Headache 1990, 30:474–480.PubMedCrossRefGoogle Scholar
  33. 33.
    Goadsby PJ, Lipton RB: A review of paroxysmal hemicranias. SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 1997, 120:193–209. State-of-the-art review of the TACs from two of the authors who coined the term and described the anatomic and pathophysiologic substrates.PubMedCrossRefGoogle Scholar
  34. 34.
    Ekbom K: Treatment of acute cluster headache with sumatriptan. N Eng J Med 1991, 325:322–326.CrossRefGoogle Scholar
  35. 35.
    Gobel H, Lindner V, Heinze A, et al.: Acute therapy for cluster headache with sumatriptan: findings of a one-year long-term study. Neurology 1998, 51:908–911. Long-term study clarifying the long-term efficacy of sumatriptan in cluster headache and the nuances associated with its use in clinical practice.PubMedGoogle Scholar
  36. 36.
    Manzoni GC: Cluster headache and lifestyle: remarks on a population of 374 male patients. Cephalalgia 1999, 19:88–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Hardebo JE, Dahlof C: Sumatriptan nasal spray (20 mg/dose) in the acute treatment of cluster headache. Cephalalgia 1998, 18:487–489.PubMedCrossRefGoogle Scholar
  38. 38.
    Andersson PG, Jespersen LT: Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. Cephalalgia 1986, 6:51–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Bahra A, Becker WJ, Blau JN: Efficacy of oral zolmitriptan in the acute treatment of cluster headache [abstract]. Cephalalgia 1999, 19:457–458.Google Scholar
  40. 40.
    Barre F: Cocaine as an abortive agent in cluster headache. Headache 1982, 22:69–73.PubMedCrossRefGoogle Scholar
  41. 41.
    Kitrelle JP, Grouse DS, Seyboro ME: Cluster headache: local anesthetic abortive agents. Arch Neurol 1985, 42:496–498.Google Scholar
  42. 42.
    Robbins L: Intranasal lidocaine for cluster headache. Headache 1995, 35:83–84.PubMedCrossRefGoogle Scholar
  43. 43.
    Anthony M, Daher BN: Mechanism of action of steroids in cluster headache. In New Advances in Headache Research 2. Edited by Clifford RF. London: Smith Gordon; 1992:271–274.Google Scholar
  44. 44.
    Gabai IJ, Spierings EHL: Prophylactic treatment of cluster headache with verapamil. Headache 1989, 29:167–168.PubMedCrossRefGoogle Scholar
  45. 45.
    Leone M, D’Amico D, Attanasio A, et al.: Verapamil is an effective prophylactic for cluster headache: results of a double-blind multicenter study versus placebo. In Cluster Headache & Related Conditions. Edited by Olesen J, Goadsby PJ. Oxford: Oxford University Press; 1999:296–299.Google Scholar
  46. 46.
    Gobel H, Holzgreve H, Heinze A, et al.: Retarded verapamil for cluster headache prophylaxis [abstract]. Cephalalgia 1999, 19:458–459.Google Scholar
  47. 47.
    Ekbom K: Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 1981, 21:132–139.PubMedCrossRefGoogle Scholar
  48. 48.
    Manzoni GC, Bono G, Lanfranchi M, et al.: Lithium carbonate in cluster headache: assessment of its short and long-term therapeutic efficacy. Cephalalgia 1983, 3:109–114.PubMedCrossRefGoogle Scholar
  49. 49.
    Bussone G, Leone M, Peccarisi C: Double blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 1990, 30:411–417.PubMedCrossRefGoogle Scholar
  50. 50.
    Stiener TJ, Hering R, Couturier ECM, et al.: Double-blind placebo-controlled trial of lithium in episodic cluster headache. Cephalalgia 1997, 17:673–675.CrossRefGoogle Scholar
  51. 51.
    Curran DA, Hinterburger H, Lance JW: Methysergide. Res Clin Stud Headache 1967, 1:74–122.Google Scholar
  52. 52.
    Hering R, Kuritzky A: Sodium valproate in the treatment of cluster headache: an open trial. Cephalalgia 1989, 9:195–198.PubMedCrossRefGoogle Scholar
  53. 53.
    Wheeler S: Significance of migrainous features in cluster headache: divalproex responsiveness. Headache 1998, 38:547–551.PubMedCrossRefGoogle Scholar
  54. 54.
    Wheeler S, Carrazana EJ: Topiramate-treated cluster headache. Neurology 1999, 53:234–236.PubMedGoogle Scholar
  55. 55.
    Brzezinski A: Melatonin in humans. N Eng J Med 1997, 336:186–195.CrossRefGoogle Scholar
  56. 56.
    Leone M, Lucini V, D’Amico D, et al.: Twenty-four hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia 1995, 15:224–229.PubMedCrossRefGoogle Scholar
  57. 57.
    Leone M, D’Amico D, Moschiano F, et al.: Melatonin versus placebo in the prophylaxis of cluster headache: a doubleblind pilot study with parallel groups. Cephalalgia 1996, 16:494–496.PubMedCrossRefGoogle Scholar
  58. 58.
    Marks DR, Rapoport A, Padla D: A double-blind placebocontrolled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993, 13:114–116.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • David W. Dodick
    • 1
  • David J. Capobianco
    • 2
  1. 1.Department of NeurologyMayo ClinicScottsdaleUSA
  2. 2.Department of NeurologyMayo ClinicJacksonvilleUSA

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