Elizabeth Dodd wrote:
Today i had to check possible treatments for cluster headache. I checked my
Harrison's, circa 2000 and then checked the 'net.
Why not use eTG complete (latest version January 2006)?
see: http://www.tg.com.au
Information on cluster headache appended.
Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
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Cluster headache
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Seen this?
Headache: introduction, symptoms and diagnosis
True cluster headache is rare and mainly seen in males. Attacks of
cluster headache are much shorter in duration than (untreated) attacks
of migraine, and unlike migraine the headache does not swap sides
between attacks. Attacks typically last from 15 minutes to 3 hours. The
headache is centred around the orbit, the pain recurring in separate
bouts, often nocturnally, with 1 to 8 attacks per day for several weeks
or months, usually with unilateral rhinorrhoea, lacrimation or
conjunctival congestion.
Preventive treatment should be commenced promptly.
verapamil sustained-release 160mg orally, daily, up to 320mg daily
OR
methysergide 1mg orally, daily, up to 8mg daily in 2 or 3 divided doses
OR
lithium 250mg orally, twice daily, titrate to serum concentration and
response.
Lithium interacts with many drugs, and toxic adverse effects can occur
even when serum concentration is in the therapeutic range.
Corticosteroids have been used to produce rapid suppression of attacks
(24 to 48 hours).
prednisolone 50mg orally, daily (morning), for 10 days, then taper over
1 week
OR
prednisone 50mg orally, daily (morning), for 10 days, then taper over 1
week.
Cluster headache may recur when corticosteroids are tapered and another
preventive drug should be substituted.
Preventive treatment is continued until attacks have ceased for one or
more weeks. The same preventive drug is usually effective if attacks
recur. If response to prophylaxis is not seen promptly, further
treatment is probably best undertaken in consultation with a
neurologist. In some cases, multiple preventive drugs may need to be
used in combination.
Acute treatment is often needed while preventive treatment is commenced.
Oxygen 100% is effective in relieving the headache in a large proportion
of patients. Lower concentrations are ineffective, thus oxygen 100% must
be administered using a tight fitting fully sealed mask at high flow
rates (10L/minute). This treatment may be undertaken at home but
requires heavy, cumbersome tanks and equipment.
oxygen 100% by inhalation, for 15 minutes.
If there has been no improvement in 15 minutes, this treatment should
cease, as further treatment is unlikely to be of benefit and there is a
small risk of oxygen toxicity with very prolonged treatment.
Sumatriptan 6mg subcutaneously has been shown to be effective for acute
treatment but is prohibitively expensive. Other treatments that may be
effective are dihydroergotamine 1mg intramuscularly, sumatriptan 20mg
intranasally or lignocaine 4% solution instilled into the nose on the
side of the pain. Nasal congestion may limit the usefulness of a nasal
preparation. Oral treatment is too slow in onset of action to be useful,
except when attacks occur at the same time each day. In this case,
pre-emptive dosing with ergotamine or the triptans may prevent the
attack developing. Ergotamine or the triptans can be used up to several
times per day if needed; surprisingly rebound headache is not seen in
these patients.
Related topics:
Warning symptoms in the diagnosis of headache (Table 7.3)
Benign headaches and symptoms (Table 7.4)
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