Episodic Cluster Headache in a Community: Clinical Features and Treatment

Abstract

ABSTRACT:Objective: To study the clinical features and treatment given to episodic cluster headache patients in the Calgary region. Patients: Fifty-one (51) patients who responded to a media campaign, had previously been diagnosed by their family physicians, and who met International Headache Society (IHS) criteria for episodic cluster headache, formed the population for this study. Methods: The media campaign consisted of newspaper advertisements and radio publicity including physician interviews and talk shows. Patients were required to complete a 200-item questionnaire detailing clinical features and treatment of their cluster headache syndrome. Each patient was also interviewed by our research nurse for clarification and proper completion of questionnaire. Results: Fifty-one percent (51%) of our patients had short headache attacks lasting one hour or less. Almost one-half (45%) had three or four attacks per 24 hour period. Eighty-six percent (86%) had been referred to a neurologist. Sixty-nine percent (69%) had never used oxygen, but of those who had, onehalf were still using it. Sumatriptan by injection had been tried by 26% of patients and of these, 93% considered it effective. Subcutaneous dihydroergotamine had been tried by 8%. For prophylaxis, 41% had tried methysergide, 31% prednisone, and 4% verapamil. Many patients had been prescribed migraine prophylactic drugs which are ineffective for cluster headache, and some had also undergone dental procedures or nasal and sinus surgeries. Conclusions: Many cluster headache patients had not, to their knowledge, been prescribed or used the best symptomatic and prophylactic treatments for cluster headache. This should be addressed through educational programs and through making up-to-date information on the treatment of cluster headache readily available to physicians and patients. RESUME: Etude regionale sur la cephalee vasculaire de Horton: manifestations cliniques et traitement Objectif: Le but de cette dtude 6tait d'6tudier les manifestations cliniques et le traitement administre' aux patients souffrant de c£phal6e vasculaire de Horton dans la region de Calgary. Patients: L'^chan-tillon est construe" de cinquante et un (51) patients qui ont nSpondu h une campagne m£diatique. lis avaient recu ce diagnostic de leur m^decin de famille et rencontraient les criteres de 1' IHS sur la cephalfie vasculaire de Horton. Methodes: La campagne m&Jiatique comprenait des annonces dans les journaux et de la publicity a la radio incluant des entrevues avec des m&iecins et des Amissions d'entrevues-vari&fis. Les patients devaient completer un questionnaire de 200 items d6taillant les manifestations cliniques et le traitement de leur cephalee. Chaque patient avait une entrevue avec notre inftrmiere de recherche pour clarifier et completer ade"quatement le questionnaire. Resutiats: Cinquante et un pourcent (51%) de nos patients avaient des crises de cfiphalde de courte durde, soit de une heure ou moins. Presque la moitie" (45%) avaient trois ou quatre crises par 24 heures. Quat...

Depression and Anxiety in Episodic and Chronic Cluster Headache: A Pilot Study

“…2 CH can be divided into episodic CH (ECH) and chronic CH (CCH) subforms, distinguished based on the presence or absence of a remission period lasting at least 1 month on an annual basis. 1 Although far less common than migraine 2 and undertreated 3 in the population, CH has a much higher incidence and prevalence than many other neurological disorders 2,4 and is commonly encountered in headache centers 5 and in neurology practice. 6,7 CH carries a significant burden in terms of occupational and social function, quality of life, and use of health-care resources.…”

“…Although far less common than migraine 2 and undertreated 3 in the population, CH has a much higher incidence and prevalence than many other neurological disorders 2,4 and is commonly encountered in headache centers 5 and in neurology practice 6,7 . CH carries a significant burden in terms of occupational and social function, quality of life, and use of health‐care resources 8 .…”

Gabapentin for the treatment and prophylaxis of cluster headache

“…Episodic cluster headache periods can last from 7 days to 1 year, with remission periods of at least 14 days; however, a typical cluster period will last between 2 weeks and 3 months. 5,6 A number of treatments have been described for cluster headache. 7,8 Abortive therapy has included use of high-flow oxygen, ergotamine, dihydroergotamine, sumatriptan, corticosteroids, oral analgesics and opioids, intranasal capsaicin, intranasal lidocaine, intravenous magnesium sulfate, and intramuscular leuprolide.…”

Corticosteroid treatment in cluster headache: Evidence, rationale, and practice

“…In summary, the quality of the evidence in support of the use of corticosteroids for CH is quite low; however, viewed as a whole, the evidence provides a clear signal of therapeutic benefit for corticosteroids in CH. Although the contribution of placebo effects to these results cannot be dismissed [48], the weight of evidence and clinical experience has sufficiently persuaded practitioners of the use of this therapy; corticosteroids are prescribed in up to one third of patients with CH, according to one survey [49].…”