Cluster Headache

Cluster headaches cause excruciating unilateral periorbital or temporal pain with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion). The diagnosis is made clinically. Acute treatment with parenteral triptans, dihydroergotamine or oxygen. Preventive verapamil, lithium, topiramate, divalproex, or a combination thereof is used.

Cluster headaches cause excruciating unilateral periorbital or temporal pain with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion). The diagnosis is made clinically. Acute treatment with parenteral triptans, dihydroergotamine or oxygen. Preventive verapamil, lithium, topiramate, divalproex, or a combination thereof is used.

(See also examination of headache patients.) Cluster headaches cause excruciating unilateral periorbital or temporal pain with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion). The diagnosis is made clinically. Acute treatment with parenteral triptans, dihydroergotamine or oxygen. Preventive verapamil, lithium, topiramate, divalproex, or a combination thereof is used. Cluster headaches affect mostly men, the typical manifestation time is between 20 and 40 years of age, the prevalence in the US is 0.4%. Most of cluster headache occurs episodically; 1-3 months, patients experiencing ? 1 attack per day, followed by a remission for months to years. Some patients suffer from nichtremittierendem cluster headache. The pathophysiology is unknown, but the periodicity suggests hypothalamic dysfunction. Alcohol intake triggers the cluster headache in the period of the attacks, but not during remission. Symptoms and complaints The Symptomevon cluster headache are unmistakable. The attacks often occur daily at the same time, they often awaken the patient from sleep. If attacks occur, the pain is always one-sided, and occurs in a orbitotemporalen distribution on the same side of the head. It is extremely distressing, reaches its maximum within minutes and usually disappears spontaneously within 30-60 min. Patients with cluster headaches are excited and go restlessly up and down, in contrast to migraine sufferers who are preferably quietly in a darkened room. The agitation is so strong that it results in bizarre behavior (eg. As the head banging against the wall). The autonomous features are clearly on the same side as the headache; they include nasal congestion, rhinorrhea, lacrimation, facial flushing and a Horner syndrome. Diagnosis Clinical Evaluation The diagnosis of cluster headache is based on the typical pattern of symptoms and the exclusion of intracranial abnormalities. Other unilateral primary headache syndromes with autonomic symptoms that are sometimes grouped with cluster headache as trigeminal autonomic cephalgias should be excluded: SUNCT (short duration unilateral neuralgiformer headache with conjunctival injection and lacrimation): The attacks of pain are very short (5-250 s) and high frequency (up to 200 pain attacks per day). Chronic paroxysmal hemicrania: The pain attacks are more frequent (> 5 per day) and significantly shorter (usually a few minutes) than in cluster headache. Hemicrania continua: It occurred to moderately severe continuous one-sided headaches that are overlaid by brief episodes of severe pain. Chronic paroxysmal hemicrania and hemicrania continua speak, unlike SUNCT and cluster headaches (and migraines), impressive on indomethacin on, but not to other NSAIDs. Treatment to Kupierung of pain attacks: parenteral Triptans, dihydroergotamine or 100% oxygen for long-term prophylaxis: Verapamil, lithium, topiramate, divalproex or a combination thereof Acute attacks of cluster headache can either (through a parenteral triptan or dihydroergotamine see Table: drugs for migraine and cluster headache *) and / or 100% (on a face mask no respiratory mask) is added oxygen to be docked. All patients need prophylactic medications because of the cluster headache occurs frequently, is difficult and very disabling. Prednisone (z. B. 60 mg po once daily) or a blockade of the occipital nerve can (with a local anesthetic and a corticosteroid) preparing directly a preliminary prevention, during preventive medication with a slower onset of action (eg., Verapamil, lithium, topiramate, divalproex) are recognized. Medications for migraine and cluster headache drug dosage * Comments prevention amitriptyline 10-100 mg po bedtime use only in migraine has anticholinergic effects; causes weight gain helpful for patients with sleep disorders Small doses are often effective atenolol 25 to 100 mg po once a day metoprolol 50-200 mg po once daily nadolol 20-160 mg po once-daily propranolol 20-160 mg po 2 times / day timolol 5-20 mg p.o. once a day use only in migraine Only using Betaezeptorenblockern has no intrinsic sympathomimetic Avoid in patients with bradycardia, hypotension, diabetes or asthma divalproex (Editor’s note: Divalproex is on the German market is not available, active ingredient used here: valproic acid.) Normal drug release : 250-500 mg po 2 times daily Retardpräparation: 500-1000 mg po once daily Can alopecia, gastrointestinal irritation, liver dysfunction, thrombocytopenia, tremor and weight gain lead lithium 300 mg po 2 to 3 times / day use can only cluster headache weakness, thirst, tremor and polyuria cause Periodic review of drug levels required OnabotulinumtoxinA – first-line drugs for chronic migraine. Topiramate 50-200 mg p.o. usually 1 times daily Can weight loss and adverse effects in the CNS (eg. as confusion, depression) cause verapamil † 240 mg 1 to 3 times / day important benefit for patients with cluster headache may hypotension and constipation cause treatment dihydroergotamine 0 , 5-1 mg sc or iv 4 mg / ml nasal spray can cause nausea contraindicated in patients with hypertension or coronary heart disease can not be used simultaneously with triptans formulation for inhalation in development triptans ‡ almotriptan 12.5 mg p.o. Eletriptan 20-40 mg po Frovatriptan 2.5 mg p.o. Naratriptan 2.5 mg p.o. Rizatriptan 10 mg p.o. Sumatriptan 50-100 mg po, 5-20 mg nasal spray, sc 6 mg or 6.5 mg transdermal patch, followed, if necessary, by a second patch after 2 h (not exceed 2 patches in 24 h) zolmitriptan 2 , 5-5 mg po or 5 mg Nasal Spray Can redness, paresthesia and a feeling of pressure in the chest or throat cause If recurrent headache repeated doses up to 3 times / day possible contraindicated in patients with coronary heart disease, uncontrolled hypertension, hemiplegic migraine or intracranial vascular use of injections or nasal spray in cluster headache valproate 500-1000 mg iv In general, for patients who triptans or vasoconstrictors Can not tolerated in long-term use to alopecia, gastrointestinal irritation, liver dysfunction, thrombocytopenia, tremor and weight gain lead Medications may, unless otherwise specified, be used for both types of headache. † In general, the formulation is used with normal release. ‡ triptans are given once and again, if necessary. Conclusion cluster headache typically causes excruciating unilateral periorbital or temporal pain with ipsilateral ptosis, lacrimation, rhinorrhea and / or nasal congestion in men aged 20-40 years. Patients usually suffer 1-3 months ? 1 attack of pain per day, followed by a remission for months to years. The diagnosis cluster Kopfschmmerz is provided based on clinical findings. Enter the docking of pain attacks a parenteral triptan or dihydroergotamine (see table: drugs for migraine and cluster headache *) and / or inhalation of 100% oxygen through a face mask (no breathing mask). Insert the prevention of pain attacks prednisone or a blockade of the greater occipital nerve for temporary relief or verapamil, lithium, topiramate and / or divalproex for long-term relief.

Health Life Media Team

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