Treatment of Intractable Cluster


  • Presented at the Annual Meeting of The AASH, June, 1985, New York.


SYNOPSISPatients with chronic cluster headache refractive to agents such as lithium carbonate, methysergide, corticosteroids, or thecalcium channel blocking agents, may respond to histamine desensitization. Intravenous histamine phosphate administeredover a 10-day treatment course in combination therapy with prophylactic agents, including H 1 and H 2 antagonists, may resultin a marked improvement in the frequency of cluster attacks. Sixty-four patients seen at the Diamond Headache Clinic wereadmitted to the Inpatient Headache Unit at Louis A. Weiss Memorial Hospital and followed for a period up to one year afterdischarge. Twenty-five patients had at least a 75% reduction in cluster attacks and all but nine patients demonstrated a partialreduction in their clusters. A group of patients who were previous treatment failures with established agents for chroniccluster were retreated with the same agent following histamine desensitization and had a significant improvement in theircluster attacks.Another group of patients responded to local application of 5% or 10% cocaine solution to the sphenopalatine ganglion. Whileuseful for some patients, the results did not achieve statistical significance compared to similarly treated patients who did notreceive cocainization of the sphenopalatine ganglion.