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Cluster headaches

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Histamine headache; Headache - histamine; Migrainous neuralgia; Headache - cluster

Treatment:

Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. Spontaneous remission may occur, or treatment may be required to prevent headaches.

Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided.

A headache diary may be helpful to identify such triggers. When a headache occurs, record the date and the time, list any activities, substances used or consumed within the previous 24 hours, and any other factors that seem significant.

Analgesic medications do not usually relieve the pain from cluster headaches. Generally, they take too long to work -- the headache is usually gone before they take effect.

Inhalation of 100% oxygen often relieves cluster headache for some people, particularly for frequent cluster headaches that occur at night.

Combination or multiple medications may be required to control symptoms of cluster headache. Because response to medications varies, several medications may be tried before a suitable treatment is found. Response can vary over time, so a previously taken effective medication or combination of medications may not have the same effect.

Ergot preparations (containing ergotamine tartrate alone or in combination with other medications) help prevent attacks for some people. The side effects, however, may be severe.

Methysergide maleate may be helpful to relieve pain and prevent attacks. It may also have severe side effects.

Other medications may be used to treat or prevent symptoms. These include the following:

• Antihistamines
• Indomethacin
• Lithium carbonate
• Calcium channel blockers
• Propranolol
• Amitriptyline
• Verapamil
• Methysergide
• Cyproheptadine

All preventive medications should be tapered off slowly during periods of remission (no headache).

Corticosteroid medications such as prednisone may provide short-term relief of cluster headaches in some people. They are not advised for long-term use because of side effects.

Surgery on certain nerve cells near the brain may rarely be recommended if medications are ineffective.

Expectations (prognosis):

Cluster headaches are not life-threatening and usually cause no permanent structural changes. However, they are chronic and may be painful enough to be debilitating as they are happening, and this may interfere with work or lifestyle. Occasionally, the pain may be severe enough to drive some individuals to attempt suicide. Side effects of medications or surgery may be severe.

Complications:

• Interference with lifestyle
• Side effects of medications (see the specific medication)
• Permanent muscle weakness in parts of the face or head after surgery
• Decreased sensation in parts of the face or head after surgery
• Horner's syndrome (not a medical problem, but can be distressing due to cosmetic effects)

Calling your health care provider:

Call for an appointment with your health care provider if cluster headaches do not respond to treatment, if headaches disturb sleep, if they happen whenever you are active, or are accompanied by other symptoms.

Emergency symptoms include drowsiness, vision changes, changes in movement or sensation, seizures , changes in alertness, and nausea or vomiting.

• Review Date: 9/10/2006
• Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

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