Systemic cluster-like headache

Systemic cluster-like headache should be suspected if the presentation is
atypical. Atypical features may include Absence of a periodic pattern
Residual headache between exacerbations Incomplete or minimal response
to standard therapy Presence of lateralizing findings on exam (except for
those of CH-related Horner's syndrome)
Most patients with cluster headache require preventive treatment because
each attack is too short in duration and too severe in intensity to treat with
only abortive medication. In addition, ergotamine, DHE, sumatriptan, and
oxygen may just postpone rather than abort the attack. Preventive therapy
for episodic cluster, in order of preference, includes ergotamine, calcium
channel blockers, methysergide, lithium, corticosteroids, divalproex, and
capsaicin. Occasionally, indomethacin is effective. If medical therapy fails
completely, surgical intervention may be beneficial for the psychologically
stable patient with strictly unilateral chronic cluster. The surgery consists
of neuronal ablation procedures directed toward the sensory input of the
trigeminal nerve and autonomic pathways, and is generally effective in 75
percent. The prognosis of cluster headaches is guarded; it is a chronic
headache that may last for the patient's life. Drug therapy may help convert
some patients from chronic to episodic cluster.
Cluster headache is a vascular condition related to migraines. It relates to
migraine in certain aspects of it pathogenesis and, consequently responds
to some of the same medications. It differs from migraine in other aspects
of its pathogenesis as well as in many apspects of its clinical presentation.
Cluster headache is also, by far, not as common as migraine and,
according to a population study, affects less than one out of 1,000 people.
As opposed to migraine, it affects mostly men with a male to female ratio of
at least 10 to 1. The age of onset of cluster headache is usually between 20
and 40 which is much later than in migraine. The clinical presentation of
cluster headache is relatively easy to diagnose.
A trial of the Hinz amino acid method is worthwhile and highly effective for
migraine headaches. It is also safe if followed according to professional
protocol. It value in cluster headaches has not been verified due to the fact
that the latter are more uncommon than ordinary migraines.