15. Cluster Headache
Pain Practice, vol. 25, pp. e70050
Abstract
INTRODUCTION: Cluster headache is a rare primary headache disorder characterized by excruciating unilateral pain around the eye, lasting between 15 and 180 min, accompanied by ipsilateral cranial autonomic symptoms. Cluster headache is classified into two forms: episodic and chronic, with chronic cluster headache defined by pain-free intervals of less than 3 months between bouts. Both drug-based and invasive treatments are available for abortive and preventive purposes. Treatment selection depends on individual efficacy and tolerance, with invasive options considered when pharmacological treatments prove ineffective. METHODS: This narrative review summarizes the literature on common practice and the evidence in the treatment of cluster headache. RESULTS: Oxygen therapy and subcutaneous sumatriptan are the most effective abortive treatments for cluster headache. Oral corticosteroid tapering regimens can be used as bridging therapy. Verapamil, lithium, topiramate, and CGRP antagonists are potential preventive medication options. Greater occipital nerve (GON) injections and radiofrequency (RF) therapy can be used as preventive treatments, though their effects are often temporary. For refractory chronic cluster headache, occipital nerve stimulation (ONS) has proven to be effective. Deep brain stimulation (DBS) may also be considered if all other treatments have failed. CONCLUSIONS: The management of cluster headache is complex due to the variable efficacy of treatments across different patients and limited evidence.
Authors 6
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Affiliation as printed
Department of Anesthesiology, Center for Pain Medicine Erasmus MC University Medical Center Rotterdam the Netherlands
Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Rolf Fronczek Aachen Department of Neurology Leiden University Medical Center Leiden the Netherlands Department of Neurology, Leiden University Medical Center (LUMC)
Leiden University Medical Center
Affiliation as printed
Department of Neurology Leiden University Medical Center Leiden the Netherlands
Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Department of Neurology Zuyderland Medical Center Heerlen the Netherlands
Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands
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Northwestern University · Uniformed Services University of the Health Sciences · Walter Reed National Military Medical Center
Affiliation as printed
Department of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center Uniformed Services University of the Health Sciences Bethesda Maryland USA
Department of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
Department of Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
Department of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Cecile C. de Vos corresponding
Affiliation as printed
Department of Anesthesiology, Center for Pain Medicine Erasmus MC University Medical Center Rotterdam the Netherlands
Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Affiliation as printed
Department of Anesthesiology, Center for Pain Medicine Erasmus MC University Medical Center Rotterdam the Netherlands
Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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