Treatment and management of cluster headache

Abstract

Cluster headache is an uncommon yet well-defined neurovascular syndrome occurring in both episodic and chronic varieties. The most striking feature of cluster headache is the unmistakable circadian and circannual periodicity. Inheritance may play a role in some families. The attacks are of extreme intensity, of short duration, occur unilaterally, and are accompanied by signs and symptoms of autonomic dysfunction. In contrast to migraine, during an attack the cluster patient prefers to pace about. Attacks frequently occur at night. Although the pathophysiology of cluster headache remains to be fully elucidated, several seminal observations have recently been made. The medical treatment of cluster headache includes both acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period. Agents used for acute therapy include inhalation of oxygen, sumatriptan, and dihydroergotamine. Transitional prophylaxis involves the short-term use of either corticosteroids or ergotamine derivatives. The cornerstone of maintenance prophylaxis is verapamil, yet methysergide, lithium, and divalproex sodium may also be employed. In some patients, melatonin or topiramate may be useful adjunctive therapies.

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“…Results suggest that MEL treatment or PG prevent agerelated thymus involution through regulation of thymocyte apoptosis which, in turn, occurs through modulation of the pituitary-adrenal axis and zinc turnover determined by the pineal hormone 231 . Studies have found melatonin useful in cocaine abuse 232 , seasonal affective disorder 233,234 , delirium 235 , headache 236,237 , gallstone 238,239 , and amyotrophic lateral sclerosis 240 . Few studies have suggested melatonin as an effective radioprotective agent [241][242][243][244][245] .…”

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“…Headaches: Several clinical studies indicate that supplementation with melatonin is an effective preventive treatment for migraines and cluster headaches 26,27 . , and is being considered for bipolar and other disorders where circadian disturbances are involved 28 .…”

Management of cluster headache in the Emergency Department

“…The pain intensifies rapidly, peaking in 5-10 min and may stay at maximal intensity for 45-90 min. After the attack the patient is pain-free but exhausted [3].…”