Treatment and management of cluster headache
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
- 4.Kudrow L: Cluster Headache: Mechanisms and Management. Oxford; New York: Oxford University Press; 1980.Google Scholar
- 8.Lovshin L: Clinical caprices of histaminic cephalgia. Headache 1961, 1:3–6.Google Scholar
- 14.Ekbom K, Greitz T: Carotid angiography in cluster headache. Acta Radiol Diagn (Stockh) 1970, 10:177–186.Google Scholar
- 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
- 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
- 31.Ekbom K: A clinical comparison of cluster headache and migraine. Acta Neurol Scand 1970, 46(suppl 1):1–10.Google Scholar
- 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
- 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
- 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
- 41.Kitrelle JP, Grouse DS, Seyboro ME: Cluster headache: local anesthetic abortive agents. Arch Neurol 1985, 42:496–498.Google Scholar
- 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
- 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.Gobel H, Holzgreve H, Heinze A, et al.: Retarded verapamil for cluster headache prophylaxis [abstract]. Cephalalgia 1999, 19:458–459.Google Scholar
- 51.Curran DA, Hinterburger H, Lance JW: Methysergide. Res Clin Stud Headache 1967, 1:74–122.Google Scholar