Advances in cluster headache management
DONALD G. VIDT, MD
TODD A. LEWIS, DO
GLEN D. SOLOMON, MDAddress reprint requests to G.D.S., Department of General Internal Medicine, A50, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Cluster headache, an uncommon, excruciating headache distinct from migraine, is often misdiagnosed. Until recently, therapy was difficult, hut verapamil has revolutionized treatment.KEY POINTS
Organic causes must be excluded in the differential diagnosis.
Treatment comprises three parts: induction, maintenance, and symptomatic therapy.
For induction therapy, a three-week course of prednisone will suppress attacks long enough for a maintenance drug to take effect.
Maintenance therapy is started at the same time as induction therapy. The most commonly used drugs are verapamil or alternatively, lithium carbonate.
Oxygen inhalation is the safest and most effective means of aborting individual attacks, but is inconvenient. Sumatriptan also aborts attacks.
The use of various therapies must be tailored to the individual patient.