Cluster Headaches (cont.)

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What is the treatment for cluster headaches?

The treatment of cluster headache can be divided into two distinct categories -- relief of the acute headache and prevention of future headaches. Oxygen delivered by face mask has been shown to help up to 70% of patients within a short period of time. However, this can be unwieldy, and most patients are unable or unwilling to transport oxygen canisters if they need to travel. Injectable sumatriptan has been shown to be beneficial in more than 75% of patients with cluster headache. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable. Dihydroergotamine, given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours. Intranasal lidocaine has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly.

Steroids can be extremely effective to decrease a headache cycle; these can be used infrequently and are for short-term use only as long-term use can lead to significant complications. Verapamil, lithium, valproic acid, topiramate, and melatonin can all be of benefit in reducing the frequency and severity of cluster cycles. In intractable cases, surgery has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency, but is associated with significant side effects and nerve loss; gamma knife lesioning and deep brain stimulation are being studied as possible options with less risk of permanent nerve change.

Medically Reviewed by a Doctor on 10/28/2013

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