Cluster Headache
Cluster Headache also known as suicide headache, is defined as an
uncommon distinctive neurovascular syndrome occurring in either episodic
or chronic patterns of that occur
periodically over a long period of time. The diseases affects over 0.1%
of the population, occurring at 45-to 60-day intervals with one to
three headaches a day lasting 45 min to 2 h(a), if untreated it, can
cause increased frequency of the attacks.
Treatments
A. In conventional medicine perspective
A.1. Non medical treatment
1. Testosterone replacement therapy
Women and men with abnormal testosterone levels causes of cluster
headache may be treated with Testosterone replacement therapy. In the
study conducted by Department of Neurology, Cleveland Clinic Foundation,
abnormal testosterone levels in patients with episodic or chronic cluster
headaches refractory to maximal medical management may predict a
therapeutic response to testosterone replacement therapy. In the
described cases, diurnal variation of attacks, a seasonal cluster
pattern, and previous, transient responsiveness to melatonin therapy
pointed to the hypothalamus as the site of neurological dysfunction(27)
2. Melatonin as adjunctive therapy
The use of melatonin as adjunctive therapy has been reported in patients with cluster headache
who have incomplete relief of their headaches on conventional therapy.
In the study by Montreal Neurological Institute, McGill University,
patients with chronic cluster headache or patients with episodic cluster headache
whose headaches are uncontrolled on conventional therapy do not appear
to gain therapeutically from the addition of melatonin to their usual
treatment regimens. It is perhaps the phase-shifting properties of
melatonin that mediate its effect in patients with episodic cluster headache, and it may be necessary to treat from the beginning of the cluster bout to reset the circadian pacemaker, thus producing a more positive outcome(28)
3. Glucocorticoid therapy
Glucocorticoid therapy has been a well-recognized abortive treatment for cluster
headaches. In the study conducted by Department of Neurology, The
Cleveland Clinic Foundation, Accumulated evidence suggests sympathetic
dysfunction--embodied in the Horner sign so commonly seen in the cluster headache--as a necessary ingredient in the inception of the cluster headache.
Sympathetic dysfunction now is thought to be associated with the
hypercortisolism, hypotestosteronism, and lower-than-normal melatonin
levels in the active cluster patient. Future research may hold the key to a fuller explanation of the complex interaction of hormonal systems in the cluster headache(29)
4. Oxygen therapy
Oxygen therapy has been well known to be used in treating cluster headache. Hyperbaric oxygen therapy (HBOT)was effective for the termination of acute migraine in an
unselected population, and weak evidence that NBOT was similarly
effective in cluster headache. Given the cost and poor availability of HBOT, more research should be done on patients unresponsive to standard therapy. NBOT is cheap, safe and easy to apply, so will probably continue to be used despite the limited evidence in this review(31)
5. Etc.
A.2 Surgical treatment
If Chronic cluster headache, also known
as chronic migrainous neuralgia, is unresponsive to medical treatment.
Surgical treatment may be another choice as some researchers suggested
that trigeminal ablative procedures
might have a dual role in the relief of medically intractable cases, by
directed against either the trigeminal nerve or the nervus
intermedius/greater superficial petrosal (NI/GSP) pathway. Among 26
patients who underwent posterior fossa trigeminal sensory
rhizotomy or percutaneous radio-frequency trigeminal gangliorhizolysis
at our institution, relief of pain was excellent in 14 (54%), fair to
good in 4 (15%), and poor in 8 (31%)(32). AS Trigeminal operative
procedures are not consistently helpful in chronic
cluster headache, while NI section has been shown to give potentially
long lasting relief but carries the potential risks of cerebellopontine
angle surgery(33)
A.3. Medication
A.3.1. Preventive medicine
1. Prophylactic medicines
a. Calcium channel blocker (Verapamil)
European guidelines suggest the use of calcium channel blocker verapamil
the at a dose of at least 240 mg daily. In the study of higher doses
conducted by Pôle Neurosciences Cliniques du CHU de Nice, CH patients
treated with verapamil VHD (≥720 mg) were considered with a systematic electrocardiogram (EKG) monitoring. Among 200 CH patients, 29 (14.8%) used verapamil
VHD (877±227 mg/day). Incidence of EKG changes was 38% (11/29). Seven
(24%) patients presented bradycardia considered as nonserious adverse
event (NSAE) and four (14%) patients presented arrhythmia (heart block)
considered as serious adverse event (SAE). Patients with EKG changes
(1,003±295 mg/day) were taking higher doses than those without EKG
changes (800±143 mg/day), but doses were similar in patients with SAE
(990±316 mg/day) and those with NSAE (1,011±309 mg/day). Around
three-quarters (8/11) of patients presented a delayed-onset cardiac
adverse event (delay ≥2 years). Our work confirms the need for
systematic EKG monitoring in CH patients treated with verapamil. Such cardiac safety assessment must be continued even for patients using VHD without any adverse event for a long time.(59)
b. Side effects are not limit to
* Dizziness
* Fatigue
* Headache and lightheadedness
* Redness, or swelling at the injection site
* allergic reactions, such as as rash, hives; itching, in some cases difficulty breathing
* Irregular heartbeat
* Etc.
2. Steroids
a. Steroid such as prednisolone/prednisone, are also effective,
but patient may have to take the medicine with a high dose in longer
time up to 6 months, but recurrence is frequent and may lead to
steroid-dependency. Some researchers found that a single suboccipital
steroid injection completely suppresses attacks in more than 80% of CH
patients. This effect is maintained for at least 4 weeks in the majority
of them(60)
b. Side effects
* Orally ingested steroids can affect the liver and in severe case can cause liver damage
* Steroids can increased levels of LDL
* leading to increased level of estrogen
* It can cause acne
* Etc.
3. Anticonvulsants such as topiramate
a. Anticonvulsants or anti seizure are medication used to treat
epileptic seizures, bipolar disorder as mood stabilizers and neuropathic
pain. In the study conducted by Department of Neurology, Canisius
Wilhelmina Ziekenhuis, anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by > or = 50% relative to placebo.(68)
b. Side Effects are not limit to
1. The medication may also increase central nervous symptoms such as
dizziness, drowsiness, unsteadiness, feeling dull difficulty
concentrating, focusing, mood swing, etc.
2. The medicine may cause gastrointestinal discomfort such as nausea, and vomiting.
3. Other side effects include liver or kidney damage and decrease the amount of platelets in your blood
4. Etc.
4. Beta-blocker (usually propranolol [Inderal] or timolol [Blocadren])
a. Beta-blocker are also known as beta-adrenergic blocking agents, use
to block norepinephrine and epinephrine from binding to beta receptors
on nerves to prevent migraine headache. Some researchers suggested that
the addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment.(65)
b. Side effects are not limit to
b.1. Beta-blocker may interact with other medicines, such as thioridazine, chlorpromazine, etc.
b.2. Most common side effects include dastrointestional discomfort such as stomach cramps, nausea and vomiting.
b.3. The medication may also increase nervous symptoms, including headache, depression, confusion, dizziness, etc.
b.4. Etc.
4. Other preventive treatment
a. Methysergide
Methysergide interacts with serotonin (5-HT) receptors in treating
migraine headache. In the study posted in European Journal of
Neuroscience suggested the support of the hypothesis that 5-HT2B receptors
located on endothelial cells of meningeal blood vessels trigger migraine
headache through the formation of nitric oxide (61), but with certain side effects, including Nausea, vomiting, diarrhea, dizziness, drowsiness, stomach upset, heartburn, etc.
b. Lithium
Lithium is a soft, silver-white metal that belongs to the alkali metal
group of chemical elements and use to to treat and prevent episodes of
mania in people with bipolar disorder. In a review of the use of Lithium treatment of chronic cluster headaches, administered lithium carbonate to two patients whose cluster
headaches had brought them to the point of contemplating suicide. Both
patients responded quite dramatically. Case 1 has now been virtually
free of headaches for over two years and Case 2 has been in remission
for over twelve months(62) vut with certain side effects, ivluding
restlessness, loss of appetite stomach pain or bloating, indigestion,
weight gain or loss, dry mouth, etc.
c. Intravenous magnesium sulfate
The treatment is effective for cluster headache in patient with Low
Serum Ionized Magnesium Levels, but some researcher sugested that
regardless of the ionized magnesium level. Measurements of ionized
magnesium may prove useful in elucidating the pathogenesis of cluster
headache and in identifying patients who may benefit from treatment with
magnesium.(63). Intravenous magnesium sulfate may not suitable to
Patient with kidney disease.
d. Melatonin
In a study conducted by Thomas Jefferson University Hospital, reported that a lack of melatonin secretion may predispose the cluster sufferer to nocturnal and, possibly, daytime attacks. Leone et al. demonstrated that melatonin could rapidly alleviate cluster attacks, but only in episodic cluster patients. We report two chronic cluster headache patients who had both daytime and nocturnal attacks that were alleviated with melatonin.(64)
A.3.2. Medication to relieve symptoms during an attack
Depending to the severity of the disease, acute attacks may be best
prescribed by a prescription version of an NSAID, of which have a potent
vasoconstricting action (constricting blood vessels) and patients are
instructed to take them during or at the onset of a cluster headache. including
1. Triptan
a. Triptan are a family of tryptamine-based drugs
used in the treatment of migraine headache and cluster headache. In the
comparison of subcutaneous sumatriptan and oral administration
formulation, subcutaneous formulation has a faster time of onset and
high rate of efficacy when compared with the oral formulation, but the
oral formulation appears to be better tolerated.(67)
b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.
2. Ergotamine
Ergotamine has been used to treat migraine
for a century and is still considered to be the most effective
therapeutic agent for acute attacks andt good responses of the
medication are associated with plasma concentrations of 0.2 ng/ml or
above within one hour of administration.
In the same study, researchers also emphasized the principal adverse effects of ergotamine include nausea, vomiting, weakness, muscle pains, paraesthesiae and coldness of the extremities and suggested dosage must therefore be limited to no more than 10mg per week to minimise toxicity.(66)
3. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/18047865
(27) http://www.ncbi.nlm.nih.gov/pubmed/16732838
(28) http://www.ncbi.nlm.nih.gov/pubmed/12390642
(29) http://www.ncbi.nlm.nih.gov/pubmed/16539869
(30) http://www.ncbi.nlm.nih.gov/pubmed/17257239
(31) http://www.ncbi.nlm.nih.gov/pubmed/18646121
(32) http://www.ncbi.nlm.nih.gov/pubmed/2423815
(33) http://www.ncbi.nlm.nih.gov/pubmed/2401621
(53) http://www.ncbi.nlm.nih.gov/pubmed/18783445
(54) http://www.ncbi.nlm.nih.gov/pubmed/20425031
(55) http://www.ncbi.nlm.nih.gov/pubmed/21197315
(56) http://www.ncbi.nlm.nih.gov/pubmed/22426836
(57) http://www.ncbi.nlm.nih.gov/pubmed/2948651
(58) http://www.ncbi.nlm.nih.gov/pubmed/10998643
(59) http://www.ncbi.nlm.nih.gov/pubmed/21258839
(60) http://www.ncbi.nlm.nih.gov/pubmed/16202532
(61) http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9568.1996.tb01583.x/abstract
(62) http://www.ncbi.nlm.nih.gov/pubmed/737393
(63) http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.1995.hed3510597.x/abstract
(64) http://www.ncbi.nlm.nih.gov/pubmed/11843873
(65) http://www.ncbi.nlm.nih.gov/pubmed/20880898
(66) http://www.ncbi.nlm.nih.gov/pubmed/18454787
Health Researcher and Article Writer. Expert in Health Benefits of Foods, Herbs, and Phytochemicals. Master in Mathematics & Nutrition and BA in World Literature and Literary criticism. All articles written by Kyle J. Norton are for information & education only.
Pages
- Home
- Kyle J. Norton's Health Tips (948) Alternative Therapy, Whole Foods and Phytochemicals
- @General Health
- @Children Health
- #Women #Health
- My List of Super Foods
- @Phytochemicals In Foods
- Men Health
- Vitamin Therapy
- @Most common Types of Cancer
- Most Common Diseases of Elders
- @Obesity's complications and Weight Loss
- @Healthy Foods Index
- @Popular Chinese Herbs
- Phytochemicals - Cancers and Diseases
- Hormones
- @Popular Herbs
- Dietary Minerals
- 5900+ Health Articles Back By Clinical Trials and Studies
- Food Therapies
- Herbal Therapies
- Phytochemical therapy
- Alternative Therapy(Yoga, Anti Aging and Regular Walking)
- Tons of Recipes
Questions or Enquiries?
Any inquiry of published articles, please e mail kylenorton@hotmail.ca
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment