Cluster Headaches
Cluster headache is rare (lifetime prevalence of 0.07%). Cluster headaches are characterized by recurrent severe headaches on one side of the head, typically around the eye. There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.
Smoking appears to increase the risk but there is conflicting evidence about the role of coffee and alcohol.
Diagnosis is entirely based on clinical features. There are no conclusive diagnostic tests or investigations available to confirm the diagnosis.
Cluster Headache Treatment
Treatment for cluster headache is divided into 2 primary categories: abortive and preventive
Preventive Cluster Headache treatments in Singapore are applied to lessen or put an end to cluster headache attacks; they are normally used together with abortive and transitional methods.
Verapamil
Verapamil, a calcium channel blocker, is the preferred first-line preventive therapy
Glucocorticoids
There are few studies to justify the effectiveness of glucocorticoids in the long run, however they can be used until other medications take effect as they seem to work for three days. Normally, people stop using them after 8–10 days of treatment.
Surgery
Nerve stimulators can be a choice for the minority of people who see no improvements with medications. Occipital nerve stimulation (ONS), may be useful. Prior studies indicate an improvement in nearly 60% of cases. This effect normally needs weeks or months to be seen.
A number of surgical procedures, such as a sphenopalatine radiofrequency or pulsed radiofrequency are available but evidence to support them is limited and there are cases of people whose symptoms worsen after these procedures.
Abortive Treatment
There are two main treatment options for acute cluster headaches: oxygen and triptans. However, they are not used enough because the syndrome is often diagnosed wrongly. During episodes of headaches, people should steer clear of factors that trigger it such as alcohol, nitroglycerine and afternoon naps.
Oxygen
Oxygen therapy can be useful for people with CH, but it does not help stop the headaches from happening in the future. Normally it is provided at a rate of 12–15 liters per minute for 15–20 minutes. A review discovered that roughly 70% show improvements in 15 minutes. However, there is little supporting evidence for the effectiveness of 100% oxygen. Hyperbaric oxygen at twice higher pressures than atmospheric pressure can ease cluster headaches.
Triptans
The other primarily recommended treatment of acute attacks is subcutaneous or intranasal sumatriptan. Sumatriptan and zolmitriptan have both been shown to improve symptoms during an attack with sumatriptan being superior. Because of the vasoconstrictive side-effect of triptans, they may be contraindicated in people with ischemic heart disease.