Difference between revisions of "Cluster headache primary prevention"

Jump to: navigation, search
(Primary Prevention)
Line 12: Line 12:
 
==== Verapamil: ====
 
==== Verapamil: ====
  
* Mostly used for episodic and chronic cluster headache
+
* Mostly used for episodic and chronic cluster headache.<ref name="pmid14648142">{{cite journal |vauthors=May A |title=Headaches with (ipsilateral) autonomic symptoms |journal=J. Neurol. |volume=250 |issue=11 |pages=1273–8 |date=November 2003 |pmid=14648142 |doi=10.1007/s00415-003-0241-y |url=}}</ref><ref name="pmid2708046">{{cite journal |vauthors=Gabai IJ, Spierings EL |title=Prophylactic treatment of cluster headache with verapamil |journal=Headache |volume=29 |issue=3 |pages=167–8 |date=March 1989 |pmid=2708046 |doi=10.1111/j.1526-4610.1989.hed2903167.x |url=}}</ref><ref name="pmid12904085">{{cite journal |vauthors=Matharu MS, Boes CJ, Goadsby PJ |title=Management of trigeminal autonomic cephalgias and hemicrania continua |journal=Drugs |volume=63 |issue=16 |pages=1637–77 |date=2003 |pmid=12904085 |doi=10.2165/00003495-200363160-00002 |url=}}</ref>
* Usually starts with a dose of 240 mg and can be titrated upto 480 mg to 960 mg , depending upon the tolerance Dose is usually increased by 80mg every 10-14 days  
+
* Usually starts with a dose of 240 mg and can be titrated upto 480 mg to 960 mg , depending upon the tolerance Dose is usually increased by 80mg every 10-14 days.<ref name="pmid17698788">{{cite journal |vauthors=Cohen AS, Matharu MS, Goadsby PJ |title=Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy |journal=Neurology |volume=69 |issue=7 |pages=668–75 |date=August 2007 |pmid=17698788 |doi=10.1212/01.wnl.0000267319.18123.d3 |url=}}</ref><ref name="pmid21258839">{{cite journal |vauthors=Lanteri-Minet M, Silhol F, Piano V, Donnet A |title=Cardiac safety in cluster headache patients using the very high dose of verapamil (≥720 mg/day) |journal=J Headache Pain |volume=12 |issue=2 |pages=173–6 |date=April 2011 |pmid=21258839 |pmc=3072493 |doi=10.1007/s10194-010-0289-x |url=}}</ref>
 
* An EKG is recommended before starting the treatment as Verapamil can cause EKG changes such as heart block and bradycardia, with a total daily dose of 480mg.
 
* An EKG is recommended before starting the treatment as Verapamil can cause EKG changes such as heart block and bradycardia, with a total daily dose of 480mg.
 
* Side effects include: edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia
 
* Side effects include: edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia

Revision as of 04:59, 23 May 2020

Cluster Headache Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Classification

Differentiating Cluster Headache from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Treatment

Medical Therapy

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cluster headache primary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cluster headache primary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onCluster headache primary prevention

CDC on Cluster headache primary prevention

Cluster headache primary prevention in the news

Blogs on Cluster headache primary prevention

Directions to Hospitals Treating Cluster headache

Risk calculators and risk factors for Cluster headache primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]


Overview

The drug of choice for primary prevention of cluster headache is Verapamil. Other agents that can be used also include glucocorticoids, topiramate and lithium.

Primary Prevention

Verapamil:

  • Mostly used for episodic and chronic cluster headache.[1][2][3]
  • Usually starts with a dose of 240 mg and can be titrated upto 480 mg to 960 mg , depending upon the tolerance Dose is usually increased by 80mg every 10-14 days.[4][5]
  • An EKG is recommended before starting the treatment as Verapamil can cause EKG changes such as heart block and bradycardia, with a total daily dose of 480mg.
  • Side effects include: edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia

Glucocorticoids:

  • Several open label studies have shown that glucocorticoids have reduced the frequency of cluster headaches
  • Prednisone 30 mg daily or a higher dose can be used
  • Dexamethasone 8 mg daily in two divided doses

Topiramate:

  • Topiramate is generally used as an add on therapy or combination therapy with Verapamil to prevent high dose use of verapamil and long term glucocorticoid therapy.

Lithium:

  • Lithium is generally used for chronic cluster headaches when the first line agents are ineffective.
  • There is very limited data about the efficacy and effectiveness of lithium.


Galcanezumab:

  • Galcanezumab is generally used for prevention of episodic cluster headaches.
  • Dose: 300 mg at the onset of cluster headache and later on once every month.

Greater occipital nerve blocks:

  • Refractory chronic cluster headaches sometimes respond temporarily to local glucocorticoid injection or greater occipital nerve block.


Others:

  • Pizotifen
  • Valproate
  • Capsaicin
  • Triptans
  • Ergotamine
  • Melatonin
  • Indomethacin

References

  1. May A (November 2003). "Headaches with (ipsilateral) autonomic symptoms". J. Neurol. 250 (11): 1273–8. doi:10.1007/s00415-003-0241-y. PMID 14648142.
  2. Gabai IJ, Spierings EL (March 1989). "Prophylactic treatment of cluster headache with verapamil". Headache. 29 (3): 167–8. doi:10.1111/j.1526-4610.1989.hed2903167.x. PMID 2708046.
  3. Matharu MS, Boes CJ, Goadsby PJ (2003). "Management of trigeminal autonomic cephalgias and hemicrania continua". Drugs. 63 (16): 1637–77. doi:10.2165/00003495-200363160-00002. PMID 12904085.
  4. Cohen AS, Matharu MS, Goadsby PJ (August 2007). "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy". Neurology. 69 (7): 668–75. doi:10.1212/01.wnl.0000267319.18123.d3. PMID 17698788.
  5. Lanteri-Minet M, Silhol F, Piano V, Donnet A (April 2011). "Cardiac safety in cluster headache patients using the very high dose of verapamil (≥720 mg/day)". J Headache Pain. 12 (2): 173–6. doi:10.1007/s10194-010-0289-x. PMC 3072493. PMID 21258839.



Linked-in.jpg