Dr. Arun Sharma

Cluster-Headaches-Treatment

Cluster Headaches Treatment in Dubai


Cluster headache causes unilateral temporal (temple area) or periorbital (in and around the eye) excruciating ,almost “suicidal” pain, lasting 15 to 180 minutes and accompanied by autonomic symptoms (watering) in the nose and eye. Headaches often recur at the same time each day during the cluster period, which can last for weeks to months. Some patients have chronic cluster headache without remission periods. The pathophysiology of cluster headache is not fully understood, but may include a genetic component. Cluster headache is more prevalent in men and typically begins between 20 and 40 years of age. Treatment focuses on avoiding triggers and includes abortive therapies, prophylaxis during the cluster period, and long-term treatment in patients with chronic cluster headache. Evidence supports the use of supplemental oxygen, sumatriptan, and zolmitriptan for acute treatment of episodic cluster headache. Verapamil is first-line prophylactic therapy and can also be used to treat chronic cluster headache.

Management

Effective management of cluster headache requires the integration of several strategies. Patient education is important, and should focus on managing or avoiding triggers, with an emphasis on smoking cessation, alcohol counseling, and lifestyle modification. Abortive treatments should be used to alleviate acute headaches. Prophylactic therapy should be started and continued for the duration of the expected cluster period, then tapered. Patients who have chronic cluster headache should continue maintenance medications indefinitely. More invasive treatment options, including surgical interventions, are used only when other treatment modalities are ineffective. Complementary and alternative medicine approaches have provided inconclusive results.

Acute or Abortive Treatment

A high quality trial showed that inhaled high-flow oxygen (12 L per minute) was more effective than placebo in eliminating pain at 15 minutes. Complete pain relief was reported in 78% of patients. Another randomized, double-blind, placebo-controlled study found that a 6-mg subcutaneous dose of sumatriptan has a number needed to treat (NNT) of 2.4 for pain relief at 15 minutes, with response in 75% of patients vs. 32% in those who received placebo. A systematic review showed that a 10-mg intranasal dose of zolmitriptan has an NNT of 2.8 for pain relief at 30 minutes. Triptans are contraindicated in patients with vascular risks, including ischemic heart disease.Hence ,till date Oxygen inhalation remains the safest,quickest, and the best treatment for headache .However the issue of availability limits it's use.

Prophylaxis

Verapamil at a minimum dosage of 240 mg per day is first-line prophylaxis for cluster headache. Electrocardiographic monitoring is necessary because of potential cardiac effects.Other prophylactic treatments that have limited evidence of success include suboccipital steroid injections, sodium valproate and topiramate . If you are someone known to you is seeking cluster headache treatment in Dubai, please visit our website www.bestneurologistdubai.com or make an appointment to visit me in person.