Cluster headache has a substantial detrimental effect on quality of life. New invasive procedures, such as hypothalamic deep brain stimulation and bilateral occipital nerve stimulation, may help patients with chronic refractory headache. This is one of the conclusions reached by Charly Gaul and co-authors from the Department of Neurology at the University Medical Center Essen in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108(33): 543-9).
Cluster headache is the commonest trigemino-autonomic headache, affecting some 120,000 people in Germany. Typically, patients suffer unilateral short attacks, which are accompanied by restlessness. The causes of cluster headache are not clear. Men are affected more often than women, with a ratio of 3.5:1.
Treating the pain attacks with trioptans or inhalation of pure oxygen is effective and well supported by scientific evidence. According to the authors, verapamil is the medication of choice for the purpose of prophylaxis, with onset of effectiveness within the first week. Lithium is an alternative, especially for treating chronic disease.