Conflict of Interest: None
Cluster Headache—Acute and Prophylactic Therapy
Article first published online: 1 FEB 2011
© 2011 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 51, Issue 2, pages 272–286, February 2011
How to Cite
Ashkenazi, A. and Schwedt, T. (2011), Cluster Headache—Acute and Prophylactic Therapy. Headache: The Journal of Head and Face Pain, 51: 272–286. doi: 10.1111/j.1526-4610.2010.01830.x
- Issue published online: 1 FEB 2011
- Article first published online: 1 FEB 2011
- Accepted for publication November 13, 2010.
- cluster headache;
- acute therapy;
- prophylactic therapy
Cluster headache (CH) pain is the most severe of the primary headache syndromes. It is characterized by periodic attacks of strictly unilateral pain associated with ipsilateral cranial autonomic symptoms. The majority of patients have episodic CH, with cluster periods that typically occur in a circannual rhythm, while 10% suffer from the chronic form, with no significant remissions between cluster periods. Sumatriptan injection or oxygen inhalation is the first-line therapy for acute CH attacks, with the majority of patients responding to either treatment. The calcium channel blocker verapamil is the drug of choice for CH prevention. Other drugs that may be used for this purpose include lithium carbonate, topiramate, valproic acid, gabapentin, and baclofen. Transitional prophylaxis, most commonly using corticosteroids, helps to control the attacks at the beginning of a cluster period. Peripheral neural blockade is effective for short-term pain control. Recently, the therapeutic options for refractory CH patients have expanded with the emergence of both peripheral (mostly occipital nerve) and central (hypothalamic) neurostimulation. With the emergence of these novel treatments, the role of ablative surgery in CH has declined.