How to relieve cluster headache?
The vascular algia of the face is an extremely painful pathology. What are the treatment options? What treatments are currently available for the treatment of the crisis and the disease-modifying treatment of cluster headache?
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A crisis ofcluster headache translates into a pain of great violence at the level of theeye and/or temple, on one side of the face only. The crisis can last from fifteen minutes to three hours. The pain is almost immediately very intense. If the pain is the symptom principle, it may be accompanied by other signs: red and/or watery eye, drooping and/or swollen eyelid, runny nose, nose blocked on the pain side. Patients affected by this disease can experience several attacks a day, often at fixed times. Attacks are usually interspersed with periods of remission, without any symptoms. The symptoms are very different from migraine.
It’s about a rare sickness affecting less than 0.5% of the population. Those affected are most often male. the diagnostic is often difficult because the clinical examination is strictly normal. It sometimes takes several years to put a name to the patient’s pain. The treatment consists of two parts: the treatment of the crisis to relieve pain and background treatment to space out attacks.
What is the treatment for the crisis?
There are two possibilities. Sumatriptan is a drug that can be injected by the subcutaneous route, usually used in the migraine management. It is issued on prescription for exceptional medication. It relieves pain in 5-10 minutes. Nevertheless, it has many contraindications because it is a powerful vasoconstrictor: history of coronary artery disease, cerebral infarction, arteritis lower limbs, uncontrolled arterial hypertension, Raynaud’s syndrome… The maximum dosage is two injections per day, while some patients have up to 10 attacks during the day.
L’oxygen therapy represents an interesting alternative. This involves putting a mask on your face for 15 minutes. This is connected to an oxygen bottle delivering a debit significant, seven liters per minute. While this treatment works well in many patients and can be used several times a day, it is more restrictive than sumatriptan. There are many safety rules to follow when you have oxygen cylinders at home or when you travel with them.
What is the background treatment?
Not all patients with cluster headache need disease-modifying therapy. It depends on the intensity of the crises, their frequency and the effectiveness of the treatment of the crisis, specific to each patient.
When a disease-modifying treatment is indicated, verapamil is the reference treatment. It is contraindicated in atrioventricular block. This is why it is necessary to make a EKG (electroencephalogram) before starting treatment. In case of failure, the carbonate of lithium represents an alternative.
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