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Cluster headache: diagnosis and treatment.
Semin Neurol. 2010 Apr; 30(2):175-85.SN

Abstract

Cluster headache is a rare yet exquisitely painful primary headache disorder occurring in either episodic or chronic patterns. The unique feature of cluster headache is the distinctive circadian and circannual periodicity in the episodic forms. The attacks are stereotypic--they are of extreme intensity and short duration, occur unilaterally, and are associated with robust signs and symptoms of autonomic dysfunction. Although the pathophysiology of cluster headache remains to be fully understood, there have been a number of recent seminal observations. To exclude structural mimics, patients presenting with symptoms suggestive of cluster headache warrant at least a brain magnetic resonance imaging (MRI) scan in their work-up. The medical treatment of cluster headache includes acute, transitional, and maintenance prophylaxis. Agents used for acute therapy include inhalation of oxygen, triptans, such as sumatriptan, and dihydroergotamine. Transitional prophylaxis refers to the short-term use of fast-acting agents. This typically involves either corticosteroids or an occipital nerve block. The mainstay of prophylactic therapy is verapamil. Yet, other medications, including lithium, divalproex sodium, topiramate, methysergide, gabapentin, and even indomethacin, may be useful when the headache fails to respond to verapamil. For medically refractory patients, surgical interventions, occipital nerve stimulation, and deep brain stimulation remain an option. As the sophistication of functional neuroimaging increases, better insight into the pathophysiological mechanisms that underlie cluster headache is expected.

Authors+Show Affiliations

Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20352587

Citation

Halker, Rashmi, et al. "Cluster Headache: Diagnosis and Treatment." Seminars in Neurology, vol. 30, no. 2, 2010, pp. 175-85.
Halker R, Vargas B, Dodick DW. Cluster headache: diagnosis and treatment. Semin Neurol. 2010;30(2):175-85.
Halker, R., Vargas, B., & Dodick, D. W. (2010). Cluster headache: diagnosis and treatment. Seminars in Neurology, 30(2), 175-85. https://doi.org/10.1055/s-0030-1249226
Halker R, Vargas B, Dodick DW. Cluster Headache: Diagnosis and Treatment. Semin Neurol. 2010;30(2):175-85. PubMed PMID: 20352587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cluster headache: diagnosis and treatment. AU - Halker,Rashmi, AU - Vargas,Bert, AU - Dodick,David W, Y1 - 2010/03/29/ PY - 2010/3/31/entrez PY - 2010/3/31/pubmed PY - 2010/6/18/medline SP - 175 EP - 85 JF - Seminars in neurology JO - Semin Neurol VL - 30 IS - 2 N2 - Cluster headache is a rare yet exquisitely painful primary headache disorder occurring in either episodic or chronic patterns. The unique feature of cluster headache is the distinctive circadian and circannual periodicity in the episodic forms. The attacks are stereotypic--they are of extreme intensity and short duration, occur unilaterally, and are associated with robust signs and symptoms of autonomic dysfunction. Although the pathophysiology of cluster headache remains to be fully understood, there have been a number of recent seminal observations. To exclude structural mimics, patients presenting with symptoms suggestive of cluster headache warrant at least a brain magnetic resonance imaging (MRI) scan in their work-up. The medical treatment of cluster headache includes acute, transitional, and maintenance prophylaxis. Agents used for acute therapy include inhalation of oxygen, triptans, such as sumatriptan, and dihydroergotamine. Transitional prophylaxis refers to the short-term use of fast-acting agents. This typically involves either corticosteroids or an occipital nerve block. The mainstay of prophylactic therapy is verapamil. Yet, other medications, including lithium, divalproex sodium, topiramate, methysergide, gabapentin, and even indomethacin, may be useful when the headache fails to respond to verapamil. For medically refractory patients, surgical interventions, occipital nerve stimulation, and deep brain stimulation remain an option. As the sophistication of functional neuroimaging increases, better insight into the pathophysiological mechanisms that underlie cluster headache is expected. SN - 1098-9021 UR - https://www.unboundmedicine.com/medline/citation/20352587/Cluster_headache:_diagnosis_and_treatment_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0030-1249226 DB - PRIME DP - Unbound Medicine ER -