Cluster headache primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]
Overview
The drug of choice for primary prevention of cluster headache is Verapamil. Other agents that can be used also include glucocorticoids, topiramate and lithium.
Primary Prevention
Verapamil:
- Mostly used for episodic and chronic cluster headache.[1][2][3]
- Usually starts with a dose of 240 mg and can be titrated upto 480 mg to 960 mg , depending upon the tolerance Dose is usually increased by 80mg every 10-14 days.[4][5]
- An EKG is recommended before starting the treatment as Verapamil can cause EKG changes such as heart block and bradycardia, with a total daily dose of 480mg.
- Side effects include: edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia
Glucocorticoids:
- Several open label studies have shown that glucocorticoids have reduced the frequency of cluster headaches
- Prednisone 30 mg daily or a higher dose can be used
- Dexamethasone 8 mg daily in two divided doses
Topiramate:
- Topiramate is generally used as an add on therapy or combination therapy with Verapamil to prevent high dose use of verapamil and long term glucocorticoid therapy.
Lithium:
- Lithium is generally used for chronic cluster headaches when the first line agents are ineffective.
- There is very limited data about the efficacy and effectiveness of lithium.
Galcanezumab:
- Galcanezumab is generally used for prevention of episodic cluster headaches.
- Dose: 300 mg at the onset of cluster headache and later on once every month.
Greater occipital nerve blocks:
- Refractory chronic cluster headaches sometimes respond temporarily to local glucocorticoid injection or greater occipital nerve block.
Others:
- Pizotifen
- Valproate
- Capsaicin
- Triptans
- Ergotamine
- Melatonin
- Indomethacin
References
- ↑ May A (November 2003). "Headaches with (ipsilateral) autonomic symptoms". J. Neurol. 250 (11): 1273–8. doi:10.1007/s00415-003-0241-y. PMID 14648142.
- ↑ Gabai IJ, Spierings EL (March 1989). "Prophylactic treatment of cluster headache with verapamil". Headache. 29 (3): 167–8. doi:10.1111/j.1526-4610.1989.hed2903167.x. PMID 2708046.
- ↑ Matharu MS, Boes CJ, Goadsby PJ (2003). "Management of trigeminal autonomic cephalgias and hemicrania continua". Drugs. 63 (16): 1637–77. doi:10.2165/00003495-200363160-00002. PMID 12904085.
- ↑ Cohen AS, Matharu MS, Goadsby PJ (August 2007). "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy". Neurology. 69 (7): 668–75. doi:10.1212/01.wnl.0000267319.18123.d3. PMID 17698788.
- ↑ Lanteri-Minet M, Silhol F, Piano V, Donnet A (April 2011). "Cardiac safety in cluster headache patients using the very high dose of verapamil (≥720 mg/day)". J Headache Pain. 12 (2): 173–6. doi:10.1007/s10194-010-0289-x. PMC 3072493. PMID 21258839.