Antonaci F, Patients fearing an attack may be afraid to go to sleep. Pucci E, Montvale, N.J.: Medical Economics Data, 2004. Cluster and related headaches. A double-blind comparison of oxygen v air inhalation. Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. As new technology and genetic studies clarify the etiology of cluster headache, it is possible that more specific therapies will emerge. Precipitants of cluster headache include hypoxia, which may occur with sleep apnea. The headaches can be predicted by keeping in mind the time when the headache usually strikes. Verapamil has been shown to be effective for prophylaxis. To see the full article, log in or purchase access. In some patients diagnosed with sleep apnea, treatment for apnea also proved to be effective for the headaches.Botulinum toxins A and B are being studied as treatments for various headaches, with evidence of some efficacy and mixed reports as to side effects. Cognitive-behavioral therapy and blood-volume-pulse biofeedback: a cross-over study with a two-year follow-up. Copyright © 2005 by the American Academy of Family Physicians.Copyright © 2020 American Academy of Family Physicians. Heinze A,

The diagnosis and optimal management of cluster headache remain challenging. See page 639 for more informationA = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series. Beard CM, Modin H, Double-blind placebo-controlled trial of lithium in episodic cluster headache. et al. It has a point prevalence of 1 in 1000 and is the most common trigeminal autonomic cephalalgia. Patients who experience attacks at night may be given 1- or 2-mg tablets orally or by suppository before bedtime.Methysergide previously was used for cluster headache prophylaxis, but its use has been discontinued in the United States because it can cause retroperitoneal, cardiac, and pleuropulmonary fibrosis. Keinath-Specht A, Martinez E, For cluster headache completely refractory to all treatments, surgical modalities and newer interventions such as the implantation of stereotactic electrodes may be useful. Blau JN. Methylergonovine, probably the active metabolite of methysergide, decreased cluster headache frequency by more than 50 percent in 19 of 20 patients in a pilot study.Verapamil is used in the treatment of chronic cluster hadache.Hypotension, bradycardia, atrioventricular block, dizziness, fatigue, nausea, constipationIn an RCT of 30 patients, 12 of 15 patients had a reduction in frequency of attacks within two weeks.Start at 300 mg orally three times daily; use blood levels to achieve therapeutic dose.Confusion, dizziness, blurry vision, diabetes insipidus, headache, nausea, polyuriaNeed close monitoring of lithium levels; test 12 hours after last dose; side effects include tremor and dysuria; check thyroid and renal function before and during treatment.Infection, cerebrospinal fluid leak, postoperative headache requiring lumbar punctureHypotension, bradycardia, atrioventricular block, dizziness, fatigue, nausea, constipationIn an RCT of 30 patients, 12 of 15 patients had a reduction in frequency of attacks within two weeks.Start at 300 mg orally three times daily; use blood levels to achieve therapeutic dose.Confusion, dizziness, blurry vision, diabetes insipidus, headache, nausea, polyuriaNeed close monitoring of lithium levels; test 12 hours after last dose; side effects include tremor and dysuria; check thyroid and renal function before and during treatment.Infection, cerebrospinal fluid leak, postoperative headache requiring lumbar punctureMicrovascular decompression of the fifth cranial nerve with or without section of the nervus intermedius was performed in 30 patients.Patients with severe snoring and cluster headache should be evaluated for sleep apnea.

Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. Common side effects include swelling, dizziness, headaches, and Diltiazem was approved for medical use in the United States in 1982.Diltiazem is relatively contraindicated in the presence of Diltiazem is one of the most common drugs that cause Intravenous diltiazem should be used with caution with beta-blockers because, while the combination is most potent at reducing heart rate, there are rare instances of Concurrent use of fentanyl with diltiazem, or any other CYP3A4 inhibitors, as these medications decrease the breakdown of fentanyl and thus increase its effects.Diltiazem, also known as (2S,3S)-3-acetoxy-5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(4-methoxyphenyl)-1,5-benzothiazepin-4(5H)-one hydrochlorid has a vasodilating activity attributed to the (2S,3S)-isomer.The synthesis of diltiazem can be obtained by oxidizing N-(N,N-dimethylethanamine)-4-aminophenol and adding 3-mercaptopropionic acid via a Diltiazem is prescribed off-label by doctors in the US for Medication for high blood pressure, heart related chest pain, and some arrhythmiasO=C2N(c3c(S[C@@H](c1ccc(OC)cc1)[C@H]2OC(=O)C)cccc3)CCN(C)CInChI=1S/C22H26N2O4S/c1-15(25)28-20-21(16-9-11-17(27-4)12-10-16)29-19-8-6-5-7-18(19)24(22(20)26)14-13-23(2)3/h5-12,20-21H,13-14H2,1-4H3/t20-,21+/m1/s1 Behaviour during a cluster headache. Sjostrand C, Grazzi L, Strategies that have proved effective for other headaches target pain intensity and resultant disability, analgesic overuse, adherence to prescribed regimens, and psychiatric comorbidity. Peccarisi C, Moschiano F, Existing effective treatments may be underused because of underdiagnosis of the syndrome. Patients occasionally undergo unnecessary procedures, such as teeth extraction, sinus washouts and intracranial surgery because they are in despair. Cluster headaches occur frequently, often at the same time of day or multiple times a day. Swanson JW, Sjostrand C, Ferrari MD, Associated signs include ptosis, ipsilateral lacrimation, conjunctival injection, and rhinorrhea. Rosum R, Oxygen and sumatriptan have been demonstrated to be effective in the acute treatment of cluster headaches.

The International Classification of Headache Disorders. Meadors L. Leone M, Hypothalamic activation in cluster headache attacks. A large number of clinical studies have now addressed the efficacy of Ca2+ channel antagonists in the prophylaxis of migraine headache. Alberca R,