Cluster Headache
JACQUELINE WEAVER-AGOSTONI, DO, MPH, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania
Am Fam Physician. 2013 Jul 15;88(2):122-128
http://www.aafp.org/afp/2013/0715/p122.pdf
Diagnostic criteria for cluster headaches includes having at least one ipsilateral symptoms in the eye, nose, or face, restlessness, agitation, headaches lasting 15-180 minutes, a headache frequency from one every other day to eight per day, unilateral location, and severe quality. Cluster headaches are typically classified based on duration and frequency of episodes. Chronic cluster headaches have a least one cluster period lasting over 12 months with a remission lasting less than one month. Episodic cluster headaches last less than 12 months but have two or more cluster periods of one week or more. The remission periods in this case should last at least one month. Triggers include alcohol, vasodilators, histamines, and tobacco. Pathophysiology is not clear.
Management includes patient education about avoiding triggers and lifestyle modification. First line abortive therapy includes triptans and supplemental oxygen. Medications with weaker evidence include intranasal lidocaine, octreotide, and ergotamine. Prophylaxis consists of verapamil. Oral steroids have not been proven effective but may be used for bridging therapy. Chronic cluster headaches can be treated with verapamil and lithium. Deep brain stimulation may also be considered.
Pregnant patients should limit the medication treatment as much as possible. gabapentin can be used in addition to the medications described above.
No comments:
Post a Comment