Headache (cont.)
How are cluster headaches diagnosed?
The diagnosis of cluster headache is made by the patient history of symptoms. The
description of the pain and it's clock-like recurrence is usually enough to make
the diagnosis.
If examined in the midst of an attack, the patient is usually in a pain
crisis and may have the eye and nose watering as described above. If the patient
presents when the pain is not present, the physical examination is normal and
the diagnosis again depends upon the patient history.
How are cluster headaches treated?
Cluster headaches may be very difficult to treat, and it make take trial and
error to find the specific treatment regimen that will work for each patient.
Since the headache recurs daily, there are two treatment needs. The pain of the
first episode needs to be controlled , and additional headaches need to be
prevented.
Initial treatment options may include the following:
- inhalation of high concentrations of oxygen (though this will not work if
the headache is well established);
- injection of tryptan medications, for example,
sumatriptan (Imitrex),
zolmitriptan (Zomig), and
rizatriptan (Maxalt) which are commonly used for
migraine treatments as well;
- injection of lidocaine, a local anesthetic, into the nostril;
- dihydroergotamine (DHE,
Migranal), a medication that causes blood vessels to
constrict;
- caffeine
Preventative cluster headache treatment options may include the following:
- calcium channel blockers [for example,
verapamil (Calan, Verelan, Verelan
PM, Isoptin, Covera-HS), diltiazem (Cardizem, Dilacor, Tiazac)]
- prednisone (Deltasone, Liquid Pred)
- antidepressant medications
- lithium (Eskalith, Lithobid)
- valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and
topiramate (Topamax) (often used for
seizure control)
Next: Can cluster headaches be prevented? »
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