eMedicine Specialties > Neurology > Headache and Pain

Cluster Headache: Follow-up

Author: Ragasri Kumar, DO, Resident Physician, Department of Neurology, Loyola University Medical Center
Coauthor(s): Rima M Dafer, MD, MPH, FAHA, Associate Professor, Department of Neurology and Neurological Surgery, Loyola University, Chicago Stritch School of Medicine
Contributor Information and Disclosures

Updated: Sep 4, 2009

Follow-up

Prognosis

  • Eighty percent of patients with episodic cluster headache (CH) tend to maintain the episodic form.
  • Episodic CH eventually transforms into chronic CH in 4-13% of patients. Intermediate (mixed) forms may occur.
  • Prolonged, spontaneous remissions have been described in up to 12% of patients in some series, particularly in episodic CH. Chronic CH is more relentless and may persist in this form in up to 55% of cases. Less frequently, chronic CH may remit into an episodic form.
  • Generally, CH is a lifelong problem.
  • Pharmacologic intervention may play a part in the transformation of chronic CH into the episodic form; otherwise, it does not influence outcome.
  • Late onset of this disorder, along with male sex and a previous history of episodic CH, predict a less favorable course.

Patient Education

Miscellaneous

Special Concerns

Cluster headache in pregnancy

  • Treatment options for cluster headache (CH) in pregnancy are poorly documented. The first line of treatment is pure oxygen via nonrebreather mask.
  • Triptans and ergots alkaloids should be avoided during pregnancy.
  • The use of selective preventive medications, which are rated pregnancy category B, should be discussed thoroughly with the patient and her obstetrician.17

 


More on Cluster Headache

Overview: Cluster Headache
Differential Diagnoses & Workup: Cluster Headache
Treatment & Medication: Cluster Headache
Follow-up: Cluster Headache
References
[ CLOSE WINDOW ]

References

  1. Goadsby PJ. Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol. Aug 2002;1(4):251-7. [Medline].

  2. Holle D, Obermann M, Katsarava Z. The electrophysiology of cluster headache. Curr Pain Headache Rep. Apr 2009;13(2):155-9. [Medline].

  3. Mendizabal JE, Umana E, Zweifler RM. Cluster headache: Horton's cephalalgia revisited. South Med J. Jul 1998;91(7):606-17. [Medline].

  4. Lodi R, Pierangeli G, Tonon C, et al. Study of hypothalamic metabolism in cluster headache by proton MR spectroscopy. Neurology. 2006;66(8):1624-6. [Medline].

  5. Kudrow L. Cluster headache: diagnosis and management. Headache. Apr 1979;19(3):142-50. [Medline].

  6. Mathew NT. Cluster Headache. Neurology. 1992;42 (suppl 2):22-31. [Medline].

  7. Peterlin BL, Levin M, Cohen JA, Ward TN. Secondary cluster headache: a presentation of cerebral thrombosis. Cephalalgia. 2006;26(8):1022-4. [Medline].

  8. Rozen TD. Trigeminal autonomic cephalalgias. Neurol Clin. May 2009;27(2):537-56. [Medline].

  9. Sewell RA. Response of cluster headache to kudzu. Headache. Jan 2009;49(1):98-105. [Medline].

  10. Ailani J, Young WB. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Curr Pain Headache Rep. Apr 2009;13(2):164-7. [Medline].

  11. Franzini A, Ferroli P, Leone M, Broggi G. Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery. May 2003;52(5):1095-9; discussion 1099-101. [Medline].

  12. Leone M, Proietti Cecchini A, Franzini A, et al. Lessons from 8 years' experience of hypothalamic stimulation in cluster headache. Cephalalgia. Jul 2008;28(7):787-97; discussion 798. [Medline].

  13. Leone M, Franzini A, Broggi G, Bussone G. Hypothalamic stimulation for intractable cluster headache. Neurology. 2006;67(1):150-2. [Medline].

  14. May A, Leone M. Update on cluster headache. Curr Opin Neurol. Jun 2003;16(3):333-40. [Medline].

  15. Leone M. Deep brain stimulation in headache. Lancet Neurol. Oct 2006;5(10):873-7. [Medline].

  16. Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. Apr 2009;49(4):571-7. [Medline].

  17. Giraud P, Chauvet S. Cluster headache during pregnancy: case report and literature review. Headache. Jan 2009;49(1):136-9. [Medline].

  18. Boes CJ, Capobianco DJ, Cutrer FM, Dodick DW, Eross EJ, Swanson JW. Headache and Other Crainofacial Pain. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J. Neurology in Clinical Practice: The Neurological Disorders. Vol 2. 4th ed. Philadelphia, Pa: Butterworth Heinemann; 2004:2090-1.

  19. Ekbom K, Nappi G. Diagnosis, differential diagnosis, and prognosis of cluster headache. In: The Headaches. 1993:585-9.

  20. Lance JW. Headache: Mechanism and Management. 5th ed. Boston, Mass: Butterworth-Heinemann; 1993.

  21. Rozen TD. Trigeminal Autonomic Cephalgias. Neurology Continium. December 2006;12:170-193.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

cluster headache, CH, Bing-Horton syndrome, histaminic cephalalgia, cluster migraine, paroxysmal nocturnal cephalalgia, red migraine, erythromelalgia of the head, sphenopalatine neuralgia, migrainous neuralgia, periorbital pain, Horton’s headache

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ragasri Kumar, DO, Resident Physician, Department of Neurology, Loyola University Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Rima M Dafer, MD, MPH, FAHA, Associate Professor, Department of Neurology and Neurological Surgery, Loyola University, Chicago Stritch School of Medicine
Rima M Dafer, MD, MPH, FAHA is a member of the following medical societies: American Academy of Neurology, American Headache Society, and American Heart Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph Carcione Jr, DO, MBA, Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans
Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.