Cluster Headaches

This type of headache is an excruciating condition that is fortunately rare. It affects 1 in 1000 men and 1 in 6000 women; most are in their twenties or older and many are smokers. It is characterised by frequently recurrent, short lasting headache and autonomic symptoms. Cluster headaches are highly recognisable. The episodic form occurs in bouts (clusters), typically of 6-12 weeks' duration once a year or every two years and at the same time of year.

Strictly unilateral intense head pain around the eye develops once or more daily, commonly at night. Cluster headaches are sudden in onset and lasts between 15 -180 minutes and can occur between once a day to eight times a day. The eye is red and waters, the nose runs or is blocked on that side, and ptosis (droopy eyelid) may occur. Atypical presentations are more common in women. In the chronic form, which is less common, no remissions occur between clusters, and a continuous milder background headache may additionally develop. The episodic form can become chronic, and the chronic form episodic, but once present, cluster headaches can persist for 30 years or more.

Management:

The most commonly used treatment for cluster headaches used world-wide is verapamil starting at 80mg tds and increasing to 1g per day. In the UK sodium valproate starting at 200mg bd and increasing to 1.2g per day is often used. Other less well evidenced treatments include gabapentin or a seven day course of of prednisolone. Oxygen can provide relief for about 70% of patients usually working within 5 - 10 minutes. Codeine and ergotamine have also been used. There is one clinical trial reporting the success of subcutaneous sumatriptan but no clear evidence of oral triptans being effective.

Source: Dr Andrew Dowson

Publication Date: July 2003

 

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