Headache (cont.)

The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.

If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depends upon the history.

Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the following headaches need to be prevented.

Initial treatment options may include one or more of the following:

• inhalation of high concentrations of oxygen (though this will not work if the headache is well established);
• injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common migraine medications;
• injection of lidocaine, a local anesthetic, into the nostril;
• dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict; and
• caffeine.

Prevention of the next cluster headache may include the following:

• calcium channel blockers (for example, verapamil [Calan, Verelan, Verelan PM, Isoptin, Covera-HS], diltiazem [Cardizem, Dilacor, Tiazac]);
• prednisone (Deltasone, Liquid Pred);
• antidepressant medications;
• lithium (Eskalith, Lithobid); and
• antiseizure medications including valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax).

Source: MedicineNet.com
http://www.medicinenet.com/headache/article.htm