Pharmacotherapy of cluster headache.
BACKGROUND
Cluster headache belongs to the trigemino-autonomic cephalgias and is one of the most devastating idiopathic pain syndromes. Despite its extreme severity and its prevalence of about 0.1%, little attention has been paid to this painful syndrome by either basic or clinical research.


METHODS
All clinical trials on the acute and prophylactic drug treatment of cluster headache are reviewed, including review articles and book chapters.


RESULTS
The treatment of cluster headache is based on acute and prophylactic drug treatment. Oxygen inhalation, subcutaneous or intranasal sumatriptan, and intranasal zolmitriptan are recommended to stop an attach. For prophylaxis, verapamil is drug of first choice. Other drugs efficacious in cluster headache are steroids, lithium, some anticonvulsants and methysergide. Recently, interventional procedures have been studied for the treatment of refractory cluster headache. In the future, new anticonvulsants and unconventional ways of immunotherapy should be evaluated.


CONCLUSIONS
In most cases, cluster headache can be treated sufficiently (i.e., with sufficient quality of life) by an individual concept of acute and prophylactic drug treatment.
Evers
Stefan
S
University of Münster, Department of Neurology, Albert-Schweitzer-Str. 33, 48129 Münster, Germany. everss@uni-muenster.de
D000927:Anticonvulsants / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003027:Cluster Headache / Q000188:drug therapy* / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000927:Anticonvulsants; D002121:Calcium Channel Blockers; D014662:Vasoconstrictor Agents