Cluster headache treatments

Cluster headache treatments

Cluster headache treatments are available that can assist a person who has cluster headaches. While effective treatments for Cluster headache exist, they are commonly underused due to misdiagnosis of the syndrome.[1] Oftentimes, it is confused with migraine or other causes of headache.[2] Treatment for Cluster headache is divided into three primary categories: abortive, transitional, and preventative.[3]

Contents

Abortive

Abortive treatments attempt to relieve the headache in as little time as possible at the onset of an attack. Because cluster headaches can be rather short in duration, an abortive treatment should take no longer than 10–15 minutes to work in order to be considered effective.[3]

Rapid inhalation of pure oxygen (i.e. oxygen therapy) is considered a first line treatment of choice by many.[1][3][4] Oxygen is typically administered via non-rebreather mask at 7-10 liters per minute for 15–20 minutes.[1][3] Patients who prove unresponsive to 7-10 LPM of Oxygen may have their recommended flow rate increased to 15 LPM.[3] Alternative and sometimes co-operative first-line treatment is subcutaneous administration of triptan drugs such as sumatriptan.[4] Typical dosages for sumatriptan is 6mg.[1] Higher doses of sumatriptan, such as 12mg subcutaneously, are not known to be more effective, but have produced greater side effects than those of 6mg doses.[1]

Non-narcotic treatments such as botox and sarapin injections have shown mixed levels of success[5] [6] While Lidocaine sprayed into the nasal cavity may relieve or stop the pain within a few minutes, long term use is not recommended due to possible side effects and damage to the nasal cavities. [7]

Interestingly, some people report that orgasm through sexual intercourse may terminate an attack.[8] It is hypothesized that this relief is achieved by acute modulation of hypothalamic function.[9][10]

Transitional

Transitional treatments are short-term preventative treatments that are intended to relieve the pain while waiting for the effects of preventative treatments to become fully active.[3]

Steroids, such as prednisolone and dexamethasone are considered a best transitional therapy, and are typically effective within 24-48 hours.[3]. This transitional therapy is generally discontinued after 8-10 days of treatment, as preventative treatments become more effective within the body, and as long-term use can result in very severe side effects.[3] Typical dosages are between 50-80mg daily and then tapered down over the course of 10-12 days.[1]

Preventive

Preventive treatments are used to provide the sufferer with a long-term reduction or elimination of the cluster headaches. These techniques are generally used in combination with abortive and transitional techniques in order to obtain the best therapeutic results.[1][3]

The calcium channel blocker Verapamil is a first-line recommended preventative therapy.[1][3] Dosages of 360-480mg daily have been found effective in reducing Cluster headache attack frequency.[1] Despite its success in randomized controlled trial, only 4 percent of patients with cluster headache report verapamil use.[1] Current European guidelines suggest the use of the drug at a dose of at least 240 mg daily.[4]

Methysergide, lithium and the anticonvulsant topiramate are recommended as alternative treatments.[4]. Additionally, Magnesium supplements have been shown to be of some benefit in about 40% of patients.[11]

Deep brain stimulation

http://www.bbc.co.uk/blogs/thereporters/ferguswalsh/2010/12/brain_surgery_to_relieve_headaches.html

Studies

New studies are being performed that may suggest alternative forms of treatment. Substantial anecdotal evidence suggests that serotonergic psychedelics such as psilocybin, LSD, and LSA (d-Lysergic acid amide) can abort cluster headache periods and extend remission.[12][13][14] Dr. Andrew Sewell and Dr. John Halpern at McLean Hospital in Boston have investigated the ability of low doses of psilocybin to treat Cluster headaches. These researchers examined medical records of 53 patients who had taken psilocybin and reported that the majority of them found partial or complete relief from cluster attacks.[15] A clinical study of these treatments is being developed by Dr. Halpern and colleagues at Harvard Medical School, McLean Hospital.[16][17] The non-hallucinogenic 2-Bromo-LSD (BOL-148) has also been found to be effective against cluster headaches in some patients, despite lacking the other effects of related serotonergic psychedelic drugs.[18]

References

  1. ^ a b c d e f g h i j ELLEN BECK, M.D., WILLIAM J. SIEBER, PH.D., and RAÚL TREJO, M.D. (2005-02-15). "Management of Cluster Headache". American Family Physician 71 (4): 717–724. PMID 15742909. http://www.aafp.org/afp/20050215/717.html. Retrieved 2009-02-17. 
  2. ^ "Vast Majority of Cluster Headache Patients Are Initially Misdiagnosed, Dutch Researchers Report". World Headache Alliance. 2003-08-21. http://www.w-h-a.org/index.cfm?spKey=archive&spId=C1F77F34-0C77-F112-299D7D175F16EE2E&highlight=cluster%20headaccce. Retrieved 2006-10-08. 
  3. ^ a b c d e f g h i j Michigan Headache & Neurological Institute. "Cluster Headache Update". http://www.mhni.com/clusterheadaches.aspx. Retrieved 2009-02-17. 
  4. ^ a b c d May A, Leone M, Afra J, Linde M, Sándor P, Evers S, Goadsby P (October 2006). "EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias". Eur J Neurol 13 (10): 1066–77. doi:10.1111/j.1468-1331.2006.01566.x. PMID 16987158.  Free Full Text (PDF)
  5. ^ Sostak P, Krause P, Förderreuther S, Reinisch V, Straube A (September 2007). "Botulinum toxin type-A therapy in cluster headache: an open study". J Headache Pain 8 (4): 236–41. doi:10.1007/s10194-007-0400-0. PMID 17901920. 
  6. ^ "Interview with Dr. Jeff Baird: Treating Migraines with Medical Acupuncture". American Academy of Medical Acupuncture.. http://www.medicalacupuncture.org/acu_info/interviews/baird.html. Retrieved 2008-08-24. 
  7. ^ Mills T, Scoggin J (Jul-Aug 1997). "Intranasal lidocaine for migraine and cluster headaches". Ann Pharmacother 31 (7-8): 914–5. PMID 9220056. 
  8. ^ Ekbom K, Lindahl J (1970). "Effect of induced rise of blood pressure on pain in cluster headache". Acta Neurol Scand 46 (4): 585–600. doi:10.1111/j.1600-0404.1970.tb05815.x. PMID 4994083. 
  9. ^ Atkinson R (November 1977). "Physical fitness and headache". Headache 17 (5): 189–91. doi:10.1111/j.1526-4610.1977.hed1705189.x. PMID 924787. 
  10. ^ Gotkine M, Steiner I, Biran I. (November 2006). "Now dear, I have a headache! Immediate improvement of cluster headaches after sexual activity". J Neurol Neurosurg Psychiatry. 77 (11): 1296. doi:10.1136/jnnp.2006.092643. PMC 2077391. PMID 17043304. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2077391. - Abstract
  11. ^ Mauskop A, Altura BT, Cracco RQ, Altura BM (1995). "Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels". Headache 35 (10): 597–600. doi:10.1111/j.1526-4610.1995.hed3510597.x. PMID 8550360. 
  12. ^ "Hallucinogenic Treatment of Neuro-Vascular Headaches". ClusterBusters. http://www.clusterbusters.com. Retrieved 2006-09-22. 
  13. ^ Mark Honigsbaum (2005-08-02). "Headache sufferers flout new drug law - Calls for clinical trials and rethink of legislation as patients claim that magic mushrooms can relieve excruciating condition". The Guardian. http://www.maps.org/sys/nq.pl?id=571&fmt=page. Retrieved 2006-09-22.  [reprint by Multidisciplinary Association for Psychedelic Studies]
  14. ^ Arran Frood (2008-10-07). "LSD cured my headache - Cluster headaches cause such severe pain that some sufferers are driven to suicide. Now one man believes he's found a surprising cure". The Independent. http://www.independent.co.uk/life-style/health-and-wellbeing/features/lsd-cured-my-headache-953406.html. Retrieved 2008-10-07. 
  15. ^ Sewell R, Halpern J, Pope H (June 2006). "Response of cluster headache to psilocybin and LSD". Neurology 66 (12): 1920–2. doi:10.1212/01.wnl.0000219761.05466.43. PMID 16801660.  - a Brief Communications, also presented as:
    Sewell, R. Andrew, M.D.; Halpern, John M., M.D. "The Effects Of Psilocybin And LSD On Cluster Headache: A Series Of 53 Cases." Abstract. Presented to the National Headache Foundation’s Annual Headache Research Summit. February, 2006.
  16. ^ "Research into psilocybin and LSD as potential treatments for people with cluster headaches". LSD and Psilocybin Research. Multidisciplinary Association for Psychedelic Studies. http://www.maps.org/research/cluster/psilo-lsd/index.html. Retrieved 2006-09-22. 
  17. ^ "Response of Cluster Headache to Psilocybin and LSD" Chapter 5 in "Psychedelic Medicine: New Evidence for Hallucinogens as Treatment" Michael Winkelman and Thomas B. Roberts (editors) (2007) Westport, CT: Praeger/Greenwood.
  18. ^ Karst M, Halpern JH, Bernateck M, Passie T (September 2010). "The non-hallucinogen 2-bromo-lysergic acid diethylamide as preventative treatment for cluster headache: an open, non-randomized case series". Cephalalgia : an International Journal of Headache 30 (9): 1140–4. doi:10.1177/0333102410363490. PMID 20713566. 

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v · d · ePathology of the nervous system, primarily CNS (G04–G47, 323–349)
Inflammation
Encephalitis (Viral encephalitis, Herpesviral encephalitis) · Cavernous sinus thrombosis · Brain abscess (Amoebic)
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