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Headaches - cluster

Description

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


Managing Cluster Headaches

Patients with cluster headaches face significant difficulties in the management and treatment of their problems:

Treating Attacks

The most effective treatments for a cluster attack are:

Relief can occur in 5 - 10 minutes.

Preventing Attacks

Because effective therapy for cluster headaches is limited, most research efforts focus on the prevention of attacks during cluster cycles. A number of treatments are available and may be used alone or in combination. In general, the steps for preventive management are:

Transitional Medications. Patients should use headache medications (typically a triptan, a corticosteroid, or ergotamine) to control any attacks during the transition to on-going maintenance drugs.

Maintenance Drugs. Prevention of attacks during a cluster cycle is extremely important. Although patients with episodic or chronic cluster headaches may be given different medications, there does not appear to be much difference in their effectiveness for either type. The following are the most commonly used preventive drugs:

Other drugs that have been tried include indomethacin, melatonin, beta blockers, tricyclic and other antidepressants, and capsaicin. Combinations may be needed.

Behavioral Treatments

Lifestyle Changes. Patients should avoid the following:

One study suggested that vigorous physical exertion at the sign of an attack onset may help reduce or even abort an attack.

Surgery

Surgery may be considered for patients with chronic cluster headaches that do not respond to medications. However, surgery is also limited in its effectiveness.

Treatment for Sleep Apnea

Patients with cluster headaches who suffer from daytime sleepiness should consider being evaluated for a possible diagnosis of sleep apnea. Anyone who has both conditions should strongly consider treatment for the apnea as possible therapy for cluster headaches.

Continuous positive airway pressure (CPAP) is the standard treatment for sleep apnea. In some studies, patients with both cluster headaches and apnea who were treated with CPAP experienced substantial reduction in the frequency and severity of cluster headaches. [For more information on CPAP and sleep apnea, see In-Depth Report #65: Sleep apnea.]


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