Cluster Headache Treatment & Management

  • Author: Ragasri Kumar, DO; Chief Editor: Howard A Crystal, MD   more...
 
Updated: Jun 22, 2011
 

Medical Care

Pharmacologic management of cluster headache (CH) may be classified as abortive/symptomatic or preventive/prophylactic. See Medication section for a detailed discussion.

Other agents that have been used to treat CH are olanzapine[8] and kudzu.[9] Their effectiveness has not been determined.

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Surgical Care

  • Invasive nerve blocks and ablative neurosurgical procedures (eg, percutaneous radiofrequency, trigeminal gangliorhizolysis, rhizotomy) all have been implemented successfully in cases of refractory CH. Percutaneous radiofrequency ablation may achieve success in 50% of patients, with fair-to-good results in 20% and failure in about 30%. Side effects include facial dysesthesia, corneal sensory loss, and anesthesia dolorosa.
  • Gamma-knife radiosurgery has provided a less invasive alternative for pervasive CH but is associated with a significantly increased risk for facial sensory disturbances.[10]
  • Botulinum toxin injections to manage cluster headaches have produced limited success.[11]
  • Greater occipital nerve block may be beneficial in aborting CH.[8]
  • Deep brain stimulation with implantation of stimulating electrodes under stereotactic guidance into the ipsilateral posterior inferior hypothalamus has emerged as a potential option for chronic CH refractory to pharmacological treatment.[12, 13, 14, 15] This technique is invasive and is associated with significant risk of complications, including intracranial hemorrhage.[16] Other serious side effects are subcutaneous infection, micturition syncope, and transient loss of consciousness.[17]
  • Sphenopalatine ganglion, which is located in pterygopalatine fossa, can be stimulated.[18] This has shown effectiveness in select patients with chronic CH.[19]
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

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: Nothing to disclose.

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. Kano H, Kondziolka D, Mathieu D, et al. Stereotactic radiosurgery for intractable cluster headache: an initial report from the North American Gamma Knife Consortium. J Neurosurg. Jun 2011;114(6):1736-43. [Medline].

  11. 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].

  12. 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].

  13. 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].

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

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

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

  17. Fontaine D, Lazorthes Y, Mertens P, Blond S, Géraud G, Fabre N. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain. Feb 2010;11(1):23-31. [Medline].

  18. Narouze SN. Role of sphenopalatine ganglion neuroablation in the management of cluster headache. Curr Pain Headache Rep. Apr 2010;14(2):160-3. [Medline].

  19. 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].

  20. Calhoun AH, Peterlin BL. Treatment of cluster headache in pregnancy and lactation. Curr Pain Headache Rep. Apr 2010;14(2):164-73. [Medline].

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

  22. 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.

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

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

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

 
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