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Headache Care

Treatment Options for Cluster Headache

Wednesday, Sep 14 2011


Cluster headache has a substantial detrimental effect on quality of life. New invasive procedures, such as hypothalamic deep brain stimulation and bilateral occipital nerve stimulation, may help patients with chronic refractory headache.

This is one of the conclusions reached by Charly Gaul and co-authors from the Department of Neurology at the University Medical Center Essen in the current issue of Deutsches Ärzteblatt International.

Cluster headache is the most common trigemino-autonomic headache, affecting some 120,000 people in Germany. Typically, patients suffer unilateral short attacks, which are accompanied by restlessness. The causes of cluster headache are not clear. Men are affected more often than women, with a ratio of 3.5:1.


Cluster Headache Overview

Cluster headache is far less common than migraine headache or tension headache. Cluster headaches begin far more dramatically, however, and remain quite unique in their course over time.

As the name suggests, the cluster headache exhibits a clustering of painful attacks over a period of many weeks. The pain of a cluster headache peaks in about 5 minutes and may last for an hour. Someone with a cluster headache may get several headaches a day for weeks at a time - perhaps months - usually interrupted by a pain-free period of variable length.

In contrast to people with migraine headache, perhaps 5-8 times as many men as women have cluster headache. Most people get their first cluster headache at age 25 years, although they may experience their first attacks in their teens to early 50s.

You can get 2 types of cluster headache:

* Episodic: This type is more common. You may have 2 or 3 headaches a day for about 2 months and not experience another headache for a year. The pattern then will repeat itself.

* Chronic: The chronic type behaves similarly but, unfortunately, you get no period of untreated sustained relief.

Treating the pain attacks with trioptans or inhalation of pure oxygen is effective and well supported by scientific evidence. According to the authors, verapamil is the medication of choice for the purpose of prophylaxis, with onset of effectiveness within the first week. Lithium is an alternative, especially for treating chronic disease.

Cluster headaches Causes

Cluster headaches are a fairly common form of chronic, repeated headaches. They are more common in men than women. The headaches can occur at any age but are most common in adolescence and middle age. They tend to run in families.

Scientists do not know exactly what causes cluster headaches, but they appear to be related to the body’s sudden release of histamine or serotonin.

The following may trigger cluster attacks:

* Alcohol and cigarette smoking
* High altitudes (trekking, air travel)
* Bright light (including sunlight)
* Exertion
* Heat (hot weather, hot baths)
* Foods high in nitrites (such as bacon and preserved meats)
* Certain medications
* Cocaine


Journal Reference:

1. Gaul C, Diener HC, Müller OM. Cluster headache - clinical features and therapeutic options. Dtsch Arztebl Int, 2011; 108(33): 543%u20139 DOI: 10.3238/arztebl.2011.0543


Deutsches Aerzteblatt International (2011, August 24).

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