Cluster headache sufferers typically experience very severe headaches of a piercing quality near one eye or temple that last for between 15 minutes and three hours. The headaches are unilateral and occasionally change sides.

Cluster headaches are frequently associated with drooping eyelids, conjunctival injection (which results in red, watery eyes), tearing, constricted pupil, eyelid edema, nasal congestion, runny nose, and sweating on the affected side of the face. The neck is often stiff or tender in association with cluster headaches, and jaw and teeth pain is sometimes reported.

During an attack, the person often is unable to be still and may pace. Sensitivity to light is more typical of a migraine, as is vomiting, but they can be present in some sufferers of cluster headache.

In episodic cluster headache, these attacks occur once or more daily, often at the same times each day, for a period of several weeks, followed by a headache-free period lasting weeks, months, or even years. Approximately 10-15% of cluster headache sufferers are chronic; they can experience multiple headaches every day for years.

Cluster headaches are occasionally referred to as "alarm clock headaches", as they can occur at night and wake a person from sleep at the same time each night or at a certain period after falling asleep. Other synonyms for cluster headache include Horton's syndrome and "suicide headaches" (a reference to the excruciating pain and resulting desperation).

The location and type of pain has been compared to a "brain-freeze" headache from rapidly eating ice cream; this analogy is limited, but may offer some insight into the cluster headache experience. Persons who have experienced both cluster headaches and other painful conditions (childbirth, migraines) report that the pain of cluster headaches is far worse. One analogy is that of a burning ice pick being repeatedly stabbed through the eye into the brain.

Incidence

Whereas other headaches, such as migraines are diagnosed more often in women, cluster headaches are diagnosed in men at a rate 2.5 to 3 times greater than in women. Between 1 and 4 people per thousand experience cluster headaches in the U.S. and Western Europe; statistics for other parts of the world are fragmentary. Latitude plays a role in the occurrence of cluster headaches, which are more common as one moves away from the equator towards the poles. It is believed that greater changes in day length are responsible for the increase.

Pathology

While the immediate cause of pain is in the trigeminal nerve, the true cause(s) of cluster headache is complex and not fully understood. Cluster headaches are a type of vascular headache and the intense pain of an attack is also associated with the dilation of blood vessels.

Read more at Wikipedia.org

• [List your site here Free!]

Is oral zolmitriptan efficacious in the acute treatment of cluster headache?
From Journal of Family Practice, 9/1/00 by Janet R. Encarnacion

Bahra A, Gawel MJ, Hardebo J-E, Millson D, Breen SA, Goadsby PJ. Oral zolmitriptan is effective in the acute treatment of cluster headache. Neurol 2000; 54:1832-39.

* BACKGROUND Acute treatments for cluster headaches include oxygen, ergotamine derivatives, and intranasal or subcutaneous sumatriptan. Although up to 95% of acute cluster headache patients treated with subcutaneous sumatriptan experience pain relief within 15 minutes,[1] the route of administration and restrictions on recommended daily dosage may limit patient use of this therapy. Oxygen is effective as abortive therapy but is frequently unavailable in settings where acute cluster headaches are experienced. Rectal and oral ergotamine derivatives have poor bioavailability, and all ergot alkaloids have a high incidence of adverse effects. Oral zolmitriptan is efficacious in the acute treatment of migraine headache. However, no previous studies have evaluated the efficacy of oral triptans in the treatment of cluster headaches.

* POPULATION STUDIED The authors of this study included patients aged 18 to 65 years who were recruited from multiple specialty referral centers in Canada, the United Kingdom, and Sweden. All subjects had an established diagnosis of chronic or episodic cluster headache, described as headaches typically lasting 45 minutes or longer that were distinguishable from other types of episodic headaches, and had tolerated previous treatment with a 5-hydroxytryptamine (5-HT) agonist, such as sumatriptan or ergotamine. The study excluded patients with a history of basilar, ophthalmoplegic, or hemiplegic migraine, and those with risk factors contraindicating the use of 5-HT agonists.

* STUDY DESIGN AND VALIDITY This randomized double-blinded placebo-controlled crossover study compared 5-mg and 10-mg doses of zolmitriptan with placebo for the acute treatment of cluster headaches. Headache intensity was rated on a diary card with a 5-point severity scale (no, mild, moderate, severe, or very severe pain); only headaches of moderate to very severe intensity were treated. Subjects were required to take the study medication within 10 minutes of headache onset, were not permitted to take escape medications, such as oxygen or analgesics, within 30 minutes of taking study medications, and were not permitted to institute prophylactic treatment during the study period. Subjects whose cluster headache period ended before treatment or who had fewer than 3 headaches before the end of the study period were excluded from the analysis. Those who failed to comply with the strict requirements for medication use were noted, but were still included in the intention-to-treat analysis. This is a well-designed study, with no major threats to validity. Patients were selected from referral centers and thus may differ from cluster headache sufferers in a primary care clinic population.

* OUTCOMES MEASURED The primary outcome was headache improvement at 30 minutes, defined as a reduction in headache intensity of 2 or more points on the 5-point scale. Secondary treatment outcomes included the proportion of subjects experiencing any headache relief at 15 and 30 minutes, experiencing headache relief at any time, using escape medication 30 to 180 minutes after treatment, having mild or no pain 30 minutes after treatment, and obtaining relief of associated symptoms. Subjects in each study arm were also asked to indicate their preferred treatment.

* RESULTS Different treatment responses were found for episodic and chronic cluster headache subgroups (the latter patients had attacks for more than a year without remission). Chronic cluster headache subjects showed no statistically significant treatment response to zolmitriptan. Compared with placebo, a greater proportion of episodic cluster headache sufferers experienced a 2-point reduction in headache intensity after taking 10 mg of zolmitriptan (47% vs 29%). Six patients would need to be treated with this dose for 1 patient to improve this much (number needed to treat [NNT]=6). Use of 10 mg zolmitriptan was also associated with statistically significant improvement in all of the secondary outcomes. Patients treated with 5 mg zolmitriptan had improvement in only 3 secondary outcomes: headache relief at any time (NNT=6), lower likelihood of escape medication use (NNT=5), and mild or no pain at 30 minutes (NNT=7). Zolmitriptan was associated with a significantly greater incidence of medication-related adverse effects (number needed to harm=5 for the 10-mg dose). The most frequently described adverse effects were paresthesia, heaviness, asthenia, nausea, dizziness, and (nonchest) tightness. No medication-related events led to withdrawal from the study. Forty-five percent of subjects preferred the 10-mg dose compared with 29% who preferred the 5-mg dose, and 26% the placebo.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Oral zolmitriptan (particularly the 10-mg dose) is efficacious in acute treatment of episodic cluster headaches. Because of its ease of administration relative to other treatment options, oral zolmitriptan may be a good choice for patients unable to use sumatriptan. However, it shares similar adverse effects with other 5-HT agonists and has a slower onset of action compared with subcutaneous sumatriptan. Head-to-head trials in primary care populations comparing oral zolmitriptan with abortive oxygen treatment and with different forms of sumatriptan are needed to better establish the role of zolmitriptan in management of cluster headaches.

REFERENCE

[1.] Hardebo JE, Dahlof C. Sumatriptan nasal spray (20 gm/dose) in the acute treatment of cluster headache. Cephalgia 1998; 18:487-89.

Return to Cluster headache

Home

Contact

Resources

Exchange Links

ebay