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Cluster headache: diagnosis and treatment.
Rashmi Halker1, Bert Vargas, David W Dodick
1Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Seminars in Neurology
|March 31, 2010
Summary
Cluster headache is a severe, unilateral headache disorder with circadian patterns. Treatment involves acute therapies like oxygen and sumatriptan, with verapamil as a primary prophylactic, and surgical options for refractory cases.
Area of Science:
- Neurology
- Headache Medicine
Background:
- Cluster headache is a rare, intensely painful primary headache disorder.
- It presents in episodic or chronic forms with distinct circadian and circannual periodicity.
- Attacks are unilateral, severe, short-lived, and accompanied by autonomic dysfunction.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and treatment of cluster headache.
- To highlight recent observations and diagnostic considerations.
- To outline current and emerging therapeutic strategies.
Main Methods:
- Literature review of cluster headache pathophysiology and treatment.
- Discussion of diagnostic work-up, including neuroimaging.
- Summary of acute, transitional, and prophylactic medical treatments.
- Overview of surgical interventions for refractory cases.
Main Results:
- Cluster headache diagnosis requires excluding structural mimics, often via MRI.
- Acute treatments include oxygen, triptans, and dihydroergotamine.
- Verapamil is the primary prophylactic agent, with alternatives like lithium and topiramate.
- Surgical options like nerve stimulation are available for refractory patients.
Conclusions:
- Understanding cluster headache pathophysiology is evolving with neuroimaging.
- Comprehensive treatment strategies are crucial, ranging from acute care to prophylaxis and surgery.
- Further research is expected to improve management of this debilitating condition.
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