Cluster headache primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]


Overview

The drug of choice for primary prevention of cluster headache is Verapamil. Other agents that can be used also include glucocorticoids, topiramate and lithium.

Primary Prevention

Verapamil:

  • Mostly used for episodic and chronic cluster headache
  • Usually starts with a dose of 240 mg and can be titrated upto 480 mg to 960 mg , depending upon the tolerance Dose is usually increased by 80mg every 10-14 days
  • An EKG is recommended before starting the treatment as Verapamil can cause EKG changes such as heart block and bradycardia, with a total daily dose of 480mg.
  • Side effects include: edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia

Glucocorticoids:

  • Several open label studies have shown that glucocorticoids have reduced the frequency of cluster headaches
  • Prednisone 30 mg daily or a higher dose can be used
  • Dexamethasone 8 mg daily in two divided doses

Topiramate:


Lithium:

Galcanezumab:

References


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