THERAPY OF CLUSTER HEADACHE GUIDELINES OF THE GERMAN-MIGRAINE-AND-HEADACHE-SOCIETY

Cluster headache is characterised by severe unilateral headache attack s lasting 15 to 180 minutes. The frequency of attacks varies between 1 attack every other day and 8 attacks per day. At least one of the fol lowing accompanying symptoms is present ipsilaterally: conjunctival in jection, nasal congestion, lacrimation, rhinorrhea; increased facial s weating, miosis, ptosis or lid edema. Cluster headache is presumed to be caused by an aseptic inflammatory process in the cavernous sinus an d the superior ophthalmic vein. Inhalation of 100% oxygen is considere d first choice in the treatment of the acute cluster attack. Sumatript an s.c. is an effective pharmacological alternative. Choice of prophyl actic drug depends on whether the cluster headache is episodic or chro nic. Verapamil, ergotamin, methysergide, steroids, lithium and valproi c acid may be used in episodic cluster headache. in chronic cluster he adache drugs of first choice are verapamil and lithium.