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• Highlights
• Introduction
• Cluster Headaches
• Causes
• Prognosis
• Risk Factors
• Diagnosis
• Managing Cluster Headaches
• Treatment for Acute Attacks
• Preventive Medications
• Surgery
• Resources
• References

Headaches - cluster

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of cluster headaches.

Highlights

FDA Warning: Serotonin Syndrome

In 2006, the FDA issued a warning against using triptan drugs and certain antidepressant medications at the same time. Combining a triptan with a selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine reuptake inhibitor (SSRI) can result in serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excess levels of the brain chemical serotonin.

• The FDA’s warning names the following antidepressants: Citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluvoxamine (Luvox), fluoxetine (Prozac), olanzapine fluoxetine combination (Symbax), sertraline (Zoloft), fluvoxamine, duloxetine (Cymbalta), venlafaxine (Effexor).
• If you are currently taking a triptan and antidepressant, talk to your doctor before stopping your medications.
• Serotonin syndrome symptoms include restlessness, hallucinations, rapid heartbeat, tremors, increased body temperature, diarrhea, nausea, and vomiting. Seek immediate medical care if you experience these symptoms.

Characteristics of Cluster Headaches

Cluster headaches are the most painful of all headaches. According to a 2006 study in the journal Headache , patients with cluster headaches also experience during attacks:

• Nausea and vomiting (28%)
• Intolerance to light or sound (61%)
• Restlessness during attacks (68%)
• Migraine-like aura before attack (23%)

Lifestyle Factors

Smoking and alcohol use are associated with cluster headaches. In the Headache study, 66% of patients were current smokers. About half reported that alcohol, usually red wine, was a trigger for the attacks.

Management of Cluster Headaches

• Treatment . Triptan drugs or oxygen therapy can provide quick pain relief and are the main ways to treat a headache attack. Sumaptriptan (Imitrex) injection is most commonly used triptan. A 2006 study in the Archives of Neurology suggested that zolmitriptan (Zomig) nasal spray also works well for cluster headache pain relief.
• Prevention . The high blood pressure medication verapamil (Calan) and corticosteroid drugs such as prednisone are the medications most commonly used to prevent cluster headaches.

• Review Date: 10/19/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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