Abstract
Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH. Botulinum toxin type A has recently been studied as a new preventive treatment for patients with chronic CH, with limited success.
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References and Recommended Reading
Rozen T: Trigeminal autonomic cephalalgias. Continuum Headache 2006, 6:171–193.
Headache Classification Committee of the International Headache Society: The International Classification of Headache Disorders 2nd ed. Cephalalgia 2004 24(Suppl 1):1–160.
May A: Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005, 366:843–855.
Dodick DW, Rozen TD, Goadsby PJ, et al.: Cluster headache. Cephalalgia 2000, 20:787–803.
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 and Related Conditions. Edited by Olesen J, Goadsby PJ. Oxford: Oxford University Press; 1999:296–299.
Bussone G, Leone M, Peccarisi C, et al.: Double blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 1990, 30:411–417.
Lainez MJ, Pascual J, Pascual AM, et al.: Topiramate in the prophylactic treatment of cluster headache. Headache 2003, 43:784–789.
Pascual J, Lainez M, Dodick D, et al.: Antiepileptic drugs for the treatment of chronic and episodic cluster headache: a review. Headache 2007, 47:81–89.
Leone M, D’Amico D, Moschiano F, et al.: Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 1996, 16:494–496.
Peres MF, Rozen TD: Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001, 10:993–995.
Burns B, Watkins L, Goadsby P: Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007, 369:1099–1106.
Blersch W, Wilhelm SM, Saskia P, et al.: Botulinum toxin A and the cutaneous nociception in humans: a prospective, double-blind, placebo-controlled, randomized study. J Neurol Sci 2002, 205:59–63.
Allergan, Inc.: Allergan announces positive top-line results from phase III BOTOX(R) headache program. Available at http://agn360.client.shareholder.com/releasedetail.cfm?ReleaseID=333850. Accessed September 2008.
Aoki KR: Evidence for antinociceptive activity of botulinum toxin Type A in pain management. Headache 2003, 43(Suppl 1):S9–S15.
Durham PL, Cady R: Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache 2004, 44:35–42.
Sostak P, Krause P, Forderreuther S, et al.: Botulinum toxin type-A therapy in cluster headache: an open study. J Headache Pain 2007, 8:236–241.
Robbins L: Botulinum toxin A for cluster headaches: 6 cases. Cephalalgia 2001, 21:499–500.
Freund BJ, Schwartz M: The use of Botulinum toxin-A in the treatment of refractory cluster headache: case reports. Cephalalgia 2000, 4:325–331.
Ekbom K, Solomon S: Management of cluster headaches. In: The Headaches, edn 2. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams & Wilkins; 2000:731–740.
Ashkenazi A, Levin M: Greater occipital nerve block for migraine and other headaches: is it useful? Curr Pain Headache Rep 2007, 11:231–235.
Ashkenazi A, Silberstein SD, Matro RA, et al.: Greater occipital nerve block for chronic daily headache using local anesthetic with or without corticosteroids: a randomized single-blind study [abstract]. Neurology 2006, 66:A223.
Ambrosini A, Vandenheede M, Rossi P, et al.: Suboccipital injection with a mixture of rapid and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005, 118:92–96.
Young WB, Marmura M, Ashkenazi A, et al.: Expert opinion: greater occipital nerve block and other anesthetic injections for primary headache disorders. Headache 2008, 48:1122–1125.
Anthony M: Arrest of attacks of cluster headache by local steroid injection of the occipital nerve. In: Migraine: Proceedings of the 5th International Migraine Symposium London 1984. Edited by Rose C. Basel: Karger; 1985:169–173.
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 Neurology 1989, 145:160–162.
Peres MFP, Stiles MA, Siow HC, et al.: Greater occipital nerve blockade for cluster headache. Cephalalgia 2002, 22:520–522.
Goadsby PJ, Zagami AS: Stimulation of the superior sagittal sinus increases metabolic activity and blood flow in certain regions of the brainstem and upper cervical spinal cord of the cat. Brain 1991, 114:1001–1011.
Bush V, Jakob W, Juergens T, et al.: Occipital nerve blockade in chronic cluster headache patients and functional connectivity between trigeminal and occipital nerves. Cephalalgia 2007, 1206–1214.
Bush V, Jacob W, Juergens T, et al.: Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalagia 2006, 26:50–55.
Young W, Cook B, Shahram M, et al.: The first 5 minutes after greater occipital nerve block. Headache 2008, 48:1126–1139.
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Ailani, J., Young, W.B. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Current Science Inc 13, 164–167 (2009). https://doi.org/10.1007/s11916-009-0028-7
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DOI: https://doi.org/10.1007/s11916-009-0028-7