Cluster Headaches And Other Trigeminal Autonomic Cephalgias

Question 1

Do cluster headaches respond readily to standard analgesics?

Answer 1

No

Question 2

What is the drug of choice for the TREATMENT of cluster headache?

Answer 2

Sumatriptan (S/C)

If an injection is unsuitable, nasal spray (sumatriptan or zolmitriptan; both unlicensed) may be used

Second line:
100% oxygen at a rate of 10-15 L/min for 10-20 min is useful in aborting an attack

Question 3

100% oxygen at a rate of _____ litres/minute for _______ minutes is useful in aborting an attack of cluster headache

Answer 3

10–15

10–20

Question 4

What are the drugs of choice for PROPHYLAXIS of cluster headache?

Answer 4

Verapamil or lithium (both unlicensed)

Question 5

When is prophylactic treatment considered for cluster headaches? (3)

Answer 5

If attacks are:

1. Frequent
2. Last over 3 weeks
3. Cannot be treated effectively

Question 6

___________ can be used for short-term prophylaxis of episodic cluster headache [unlicensed use] either as monotherapy, or in combination with verapamil hydrochloride during verapamil titration

Answer 6

Prednisolone

Question 7

__________, used on an intermittent basis is an alternative for patients with short bouts of cluster headache, but it should not be used for prolonged periods

Answer 7

Ergotamine tartrate

Question 8

What are the characteristics of trigeminal autonomic cephalgias? (3)

Answer 8

A group of primary headaches that are characterized by:

• unilaterality of pain in the trigeminal distribution
• a relatively short duration of symptoms
• associated ipsilateral cranial autonomic symptoms (eg Horner’s, lacrimation, nasal congestion)

Question 9

What conditions are included in the Trigeminal Autonomic Cephalgias? (3)

Answer 9

1. Cluster headaches
2. Paroxysmal hemicrania (PH)
3. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)

Question 10

What is the mechanism of action of sumatriptan?

Answer 10

Selective 5-HT1 (serotonin) activator

Sulfonamide triptan with vasoconstrictor activity; may lead to relief of pain from vascular headaches

Question 11

What is the mechanism of action of verapamil?

Answer 11

CCB; interferes with inward displacement of Ca ions through the slow channels of active cell membranes

In the prophylaxis of cluster headache, verapamil is suspected to exhibit its effect through CGRP-release modification and possible circadian rhythm modification

Question 12

What is the mechanism of action of ergotamine tartrate?

Answer 12

5-HT (serotonin) selective activator located in intracranial blood vessels

Activation leads to vasoconstriction and reduction in blood flow in cerebral arteries that may lead to relief of vascular headaches