Current Treatment Options in Neurology

, Volume 5, Issue 6, pp 455–466

Cluster headache and cluster variants

  • Marc E. Lenaerts
Article

Opinion statement

Patients must be cognizant of the time course of the cluster headache periods to optimally tailor their therapy. Steroids provide the fastest onset of prophylactic effect. Once steroids are initiated, it remains difficult to wean patients off of them, and that is why it is always recommended to associate another prophylactic agent from the onset with the steroids. All triptans can be considered; however, only injectable sumatriptan and zolmitriptan have been the subject of controlled studies, and the former remains the gold standard because of its speed of action. Lithium, although not a first-line therapy, remains mainly efficacious for the chronic form of cluster headache. There does not seem a significant tendency for analgesic rebound-withdrawal headache with cluster headache compared with migraine. Scientific studies of the treatment of cluster headache are inherently difficult because of the rarity of the syndrome, the short duration of attacks, and the relatively short duration of the cluster period, along with the presence of spontaneous remissions. Moreover, still a significant proportion of the available evidence on this subject is uncontrolled. Active, rather than placebo, control individuals are recommended. As far as surgical procedures are concerned, although only recently introduced and less documented, gamma-knife radiosurgery should be preferred to the procedures associated with craniotomy, which are inherently associated with a higher complication potential risk.

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References and Recommended Reading

  1. 1.
    Horton BT: Histaminic cephalgia. Lancet 1952, 72:92.Google Scholar
  2. 2.
    Cademartiri C, Torelli P, Cologno D, Manzoni GC: Upper and lower cluster headache: clinical and pathogenetic observations in 608 patients. Headache 2002, 42:630–637.PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    Tonon C, Guttmann S, Volpini M, et al.: Prevalence and incidence of cluster headache in the Republic of San Marino. Headache 2003, 43:307.CrossRefGoogle Scholar
  5. 5.
    Manzoni GC: Male preponderance of cluster headache is progressively decreasing over the years. Headache 1997, 37:588.PubMedCrossRefGoogle Scholar
  6. 6.
    El Amrani M, Ducros A, Boulan P, et al.: Familial cluster headache: a series of 186 index patients. Headache 2002, 42:974–977.PubMedCrossRefGoogle Scholar
  7. 7.
    Kudrow L: Thermographic and Doppler flow asymmetry in cluster headache. Headache 1979, 19:204–208.PubMedCrossRefGoogle Scholar
  8. 8.
    Afra J, Cecchini AP, Schoenen J: Craniometric measures in cluster headache. Cephalalgia 1998, 18:143–145.PubMedCrossRefGoogle Scholar
  9. 9.
    Hardebo JE: How cluster headache is explained as an intracavernous inflammatory process lesioning sympathetic fibers. Headache 1994, 34:125–131.PubMedCrossRefGoogle Scholar
  10. 10.
    Goadsby PJ, Edvinsson L: Human in vivo evidence of trigeminovascular activation in cluster headache. Brain 1994, 117:427–434.PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Kudrow L, Kudrow DB: Inheritance of cluster headache and its possible link to migraine. Headache 1994, 34:400–407.PubMedCrossRefGoogle Scholar
  13. 13.
    Torelli P, Manzoni G: What predicts the evolution from episodic to chronic cluster headache? Headache 2003, 43:306.CrossRefGoogle Scholar
  14. 14.
    Boes CJ, Dodick DW: Refining the clinical spectrum of chronic paroxysmal hemicrania: a review of 74 patients. Headache 2002, 42:699–708.PubMedCrossRefGoogle Scholar
  15. 15.
    Pareja J, Caminero A, Sjaastad O: SUNCT syndrome: diagnosis and treatment. CNS Drugs 2002, 16:373–383.PubMedCrossRefGoogle Scholar
  16. 16.
    Matharu MS, Cohen AS, Boes CJ, Gaodsby PJ: Shortlasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review. Curr Pain Headache Rep 2003, 7:308–318.PubMedCrossRefGoogle Scholar
  17. 17.
    Pareja JA, Ruiz J, de Isla C, et al.: Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia 1996, 6:93–96.CrossRefGoogle Scholar
  18. 18.
    Tepper SJ, Rapoport AM, Sheftell FD: Ethical considerations in cluster headache research. Curr Pain Headache Rep 2002, 6:47–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Moore K: Cluster headache: the challenge of clinical trials. Headache 2003, 43:307.CrossRefGoogle Scholar
  20. 20.
    Kudrow L: In Cluster Headache: Mechanisms and Management. London: Oxford University Press; 1980.Google Scholar
  21. 21.
    Couch JR Jr., Ziegler DK: Prednisone therapy for cluster headache. Headache 1978, 18:219–221.PubMedCrossRefGoogle Scholar
  22. 22.
    Ekbom KA: Ergotamine tartrate orally in Horton’s “histaminic cephalgia” (also called Harris’s “ciliary neuralgia”). Acta Psychiatr Scand 1947, 46:106–113.Google Scholar
  23. 23.
    Kudrow L: Cluster headache: diagnosis, management, and treatment. In Wolff’s Headache and Other Head Pain, edn 6. Edited by Dalessio DJ, Silberstein SD. Oxford: Oxford University Press; 1993.Google Scholar
  24. 24.
    Ekbom K, Hardebo HE: Cluster headache: etiology, diagnosis and management. Drugs 2002, 62:61–69.PubMedCrossRefGoogle Scholar
  25. 25.
    Gabai IJ, Spierings EL: Prophylactic treatment of cluster headache with verapamil. Headache 1989, 29:167–168.PubMedCrossRefGoogle Scholar
  26. 26.
    Leone M, D’Amico D, Frediani F, et al.: Verapamil in the prophylactic treatment of episodic cluster headache: a double-blind study versus placebo. Neurology 2000, 54:1382–1385.PubMedGoogle Scholar
  27. 27.
    Steiner TJ, Hering R, Couturier EG, et al.: Double-blind placebo-controlled trial of lithium in episodic cluster headache. Cephalalgia 1997, 17:673–675.PubMedCrossRefGoogle Scholar
  28. 28.
    Ekbom K: Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 1981, 21:132–139.PubMedCrossRefGoogle Scholar
  29. 29.
    Bussone G. Leone M, Peccarisi C: Double-blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 1990, 30:411–417.PubMedCrossRefGoogle Scholar
  30. 30.
    Curran DA, Hinterberger H, Lance JW: Methysergide. Res Clin Study Headache 1967, 1:74–122.Google Scholar
  31. 31.
    Ekbom K: Prophylactic treatment of cluster headache with a new serotonin antagonist, BC 105. Acta Neurol Scand 1969, 45:601–610.PubMedCrossRefGoogle Scholar
  32. 32.
    Hering R, Kuritsky A: Sodium valproate in the treatment of cluster headache: an open clinical trial. Cephalalgia 1989, 9:195–198.PubMedCrossRefGoogle Scholar
  33. 33.
    Wheeler S: Significance of migrainous features in cluster headache: divalproex responsiveness. Headache 1998, 38:547–551.PubMedCrossRefGoogle Scholar
  34. 34.
    El Amrani M, Massiou H, Bousser MG: A negative trial of sodium valproate in cluster headache: methodological issues. Cephalalgia 2002, 22:205–208.PubMedCrossRefGoogle Scholar
  35. 35.
    Wheeler SD, Carranzana EJ: Topiramate-treated cluster headache. Neurology 1999, 53:234–236.PubMedGoogle Scholar
  36. 36.
    Forderreuther S, Mayer M, Straube A: Treatment of cluster headache with topiramate: effects and sideeffects in five patients. Cephalalgia 2002, 22:186–189.PubMedCrossRefGoogle Scholar
  37. 37.
    Leandri M, Luzzani M, Cruccu G, Gottlieb A: Drugresistant cluster headache responding to gabapentin: a pilot study. Cephalalgia 2001, 21:744–746.PubMedCrossRefGoogle Scholar
  38. 38.
    Eekers PJE, Koehler PJ: Naratriptan prophylactic treatment in cluster headache. Cephalalgia 2001, 21:75–76.PubMedCrossRefGoogle Scholar
  39. 39.
    Mulder LJMM, Spierings ELH: Naratriptan in the preventive treatment of cluster headache. Cephalalgia 2002, 22:815–817.PubMedCrossRefGoogle Scholar
  40. 40.
    Kudrow L: Response of cluster headache attacks to oxygen inhalation. Headache 1981, 21:1–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Di Sabato F, Fusco BM, Pelaia P, Giacovazzo M: Hyperbaric oxygen therapy in cluster headache. Pain 1993, 52:243–245.PubMedCrossRefGoogle Scholar
  42. 42.
    Pascual J, Peralta G, Sancez U: Preventive effects of hyperbaric oxygen in cluster headache. Headache 1995, 35:260–261.PubMedCrossRefGoogle Scholar
  43. 43.
    Nilsson Remahl AIM, Ansjon R, Lind F, Waldenlind E: Hyperbaric oxygen treatment of active cluster headache: a double-blind placebo-controlled cross-over study. Cephalalgia 2002, 22:730–739.PubMedCrossRefGoogle Scholar
  44. 44.
    Ekbom K: Treatment of acute cluster headache with sumatriptan. N Engl J Med 1991, 325:322–326.CrossRefGoogle Scholar
  45. 45.
    Ekbom K, Monstad I, Prusinski A, et al.: Subcutaneous sumatriptan in the acute treatment of cluster headache: a dose comparison study. The Sumatriptan Cluster Headache Study Group. Acta Neurol Scand 1993, 88:63–69.PubMedCrossRefGoogle Scholar
  46. 46.
    Ekbom K: Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Sumatriptan Cluster Headache Long-term Study Group. Cephalalgia 1995, 15:230–236.PubMedCrossRefGoogle Scholar
  47. 47.
    Van Vliet JA, Bahra A, Martin V, et al.: Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology 2003, 60:630–633.PubMedCrossRefGoogle Scholar
  48. 48.
    Hardebo JE, Dahlof C: Sumatriptan nasal spray in the acute treatment of cluster headache. Cephalalgia 1998, 18:487–489.PubMedCrossRefGoogle Scholar
  49. 49.
    Bahra A, Gawel MG, Hardebo JE, et al.: Oral zolmitriptan is effective in the acute treatment of cluster headache. Neurology 2000, 54:1832–1839.PubMedGoogle Scholar
  50. 50.
    Friedman AP, Mikropoulos HE: Cluster headaches. Neurology 1958, 8:653–663.PubMedGoogle Scholar
  51. 51.
    Mather PJ, Siberstein SD, Schulman EA, Hopkins MM: The treatment of cluster headache with repetitive intravenous dihydroergotamine. Headache 1991, 31:525–532.PubMedCrossRefGoogle Scholar
  52. 52.
    Andersson PG, Jespersen LT: Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. Cephalalgia 1986, 6:51–54.PubMedCrossRefGoogle Scholar
  53. 53.
    Robbins L: Intranasal lidocaine for cluster headache. Headache 1995, 35:83–84.PubMedCrossRefGoogle Scholar
  54. 54.
    Costa A, Pucci E, Antonaci F, et al.: The effect of cocaine and lidocaine in nitroglycerin-induced attacks in cluster headache. Cephalalgia 2000, 20:85–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Saper JR, Klapper J, Mathew NT, et al.: Intranasal civamide for the treatment of episodic cluster headaches. Arch Neurol 2002, 59:990–994.PubMedCrossRefGoogle Scholar
  56. 56.
    Bigo A, Delrieu F, Bousser MG: Treatment of vascular pain of the face by methylprednisolone injection into the area of the greater occipital nerve: 16 cases. Rev. Neurol 1989, 145:160–162.PubMedGoogle Scholar
  57. 57.
    Peres MFP, Stiles MA, Siow HC, et al.: Greater occipital nerve blockade for cluster headache. Cephalalgia 2002, 22:520–522.PubMedCrossRefGoogle Scholar
  58. 58.
    Peres MF, Rozen TD: Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001, 21:933–935.CrossRefGoogle Scholar
  59. 59.
    Pringsheim T, Magnoux E, Dobson CF, et al.: Melatonin as adjunctive therapy in the prophylaxis of cluster headache: a pilot study. Headache 2002, 42:787–792.PubMedCrossRefGoogle Scholar
  60. 60.
    Nicolodi M, Sicuteri F, Poggioni M: Hypothalamic modulation of nociception and reproduction in cluster headache. I. Therapeutic trials of leuprolide. Cephalalgia 1993, 13:253–257.PubMedCrossRefGoogle Scholar
  61. 61.
    Hering-Hanit G, Gadoth N: The use of baclofen in cluster headache. Curr Pain Headache Rep 2001, 5:79–82.PubMedCrossRefGoogle Scholar
  62. 62.
    Piper DR, Dickerson J, Hassenbusch SJ: Percutaneous retrogasserian glycerol rhizolysis for treatment of chronic intractable cluster headaches: long-term results. Neurosurgery 2000, 46:363–368.CrossRefGoogle Scholar
  63. 63.
    Onofrio BM, Campbell JK: Surgical treatment of chronic cluster headache. Mayo Clin Proc 1986, 61:537–544.PubMedGoogle Scholar
  64. 64.
    Mathew NT, Hurt W: Percutaneous trigeminal radiofrequency gangliorhizolysis in intractable cluster headache. Headache 1988, 5:328–331.CrossRefGoogle Scholar
  65. 65.
    Taha JM, Tew JM, Jr.: Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. Headache 1995, 35:193–196.PubMedCrossRefGoogle Scholar
  66. 66.
    Gregoire A, Clair C, Delabrousse E, et al.: CT-guided gangliolysis of the sphenopalatine ganglion for management of refractory trigeminal neuralgia. J Radiol 2002, 83:1082–1084.PubMedGoogle Scholar
  67. 67.
    Ford RG, Ford KT, Swaid S, et al.: Gamma knife treatment of refractory cluster headache. Headache 1998, 38:3–9.PubMedCrossRefGoogle Scholar
  68. 68.
    Lovely TJ, Kotsiakis X, Jannetta PJ: The surgical management of chronic cluster headache. Headache 1998, 38:590–594.PubMedCrossRefGoogle Scholar
  69. 69.
    Kirkpatrick PJ, O’Brien MD, MacCabe JJ: Trigeminal nerve section for chronic migrainous neuralgia. Br J Neurosurg 1993, 7:483–490.PubMedCrossRefGoogle Scholar
  70. 70.
    Jarrar RG, Black DF, Dodick DW, Davis DH: Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 2003, 22:1360–1362. A good article.Google Scholar
  71. 71.
    Leone M, Franzini A, Broggi G, Bussone G: Hypothalamic deep brain stimulation for intractable chronic cluster headache: a 3-year follow-up. Neurol Sci 2003, 24:S143-S145. A good article.PubMedGoogle Scholar
  72. 72.
    Mathew NT, Kailasam J, Fischer A: Responsiveness to celecoxib in chronic paroxysmal hemicrania. Neurology 2000, 55:316.PubMedGoogle Scholar
  73. 73.
    Lisotto C, Maggioni F, Mainardi F, Zanchin G: Rofecoxib for the treatment of chronic paroxysmal hemicrania. Cephalalgia 2003, 23:318–320.PubMedCrossRefGoogle Scholar
  74. 74.
    Warner JS, Wamil AW, McLean MJ: Acetazolamide for the treatment of chronic paroxysmal hemicrania. Headache 1994, 34:597–599.PubMedCrossRefGoogle Scholar
  75. 75.
    Lenaerts M, Diederich N, Dang P: A patient with SUNCT cured by the Jannetta procedure: proceedings of the 8th Congress of the International Headache Society, Amsterdam, 1997. Cephalalgia 1997, 17:460.Google Scholar
  76. 76.
    Jacome DE: Exploding head syndrome and idiopathic stabbing headache relieved by nifedipine. Cephalalgia 2001, 21:617–618.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Marc E. Lenaerts
    • 1
  1. 1.Department of Neurology, Headache SectionUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA

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