Bob Johnson
CH.com Alumnus
 
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"Only the educated are free." -Epictetus
Posts: 5965
Kennett Square, PA (USA)
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(This med has been consistently effective for me.)
Headache 2001 Sep;41(8):813-6
Olanzapine as an Abortive Agent for Cluster Headache.
Rozen TD. Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.
OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and TWO PATIENTS BECAME HEADACHE-FREE AFTER TAKING THE DRUG. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.
PMID 11576207 PubMed
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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ. ===== Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ] ===== =====
Ther Adv Neurol Disord. 2010 May;3(3):187-195.
Hypothalamic deep brain stimulation in the treatment of chronic cluster headache. Leone M, Franzini A, Cecchini AP, Broggi G, Bussone G.
Headache Centre, Neuromodulation and Neurological Department, Fondazione Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy.
Abstract Cluster headache (CH) is a short-lasting unilateral headache associated with ipsilateral craniofacial autonomic manifestations. A POSITRON EMISSION TOMOGRAPHY (PET) STUDY HAS SHOWN THAT THE POSTERIOR HYPOTHALAMUS IS ACTIVATED DURING CH ATTACKS, SUGGESTING THAT HYPOTHALAMIC HYPERACTIVITY PLAYS A KEY ROLE IN CH PATHOPHYSIOLOGY. ON THIS BASIS, STIMULATION OF THE IPSILATERAL POSTERIOR HYPOTHALAMUS WAS HYPOTHESIZED TO COUNTERACT SUCH HYPERACTIVITY TO PREVENT INTRACTABLE CH. TEN YEARS AFTER ITS INTRODUCTION, HYPOTHALAMIC STIMULATION HAS BEEN PROVED TO SUCCESSFULLY PREVENT ATTACKS IN MORE THAN 60% OF 58 HYPOTHALAMIC IMPLANTED DRUG-RESISTANT CHRONIC CH PATIENTS. The implantation procedure has generally been proved to be safe, although it carries a small risk of brain haemorrhage. Long-term stimulation is safe, and nonsymptomatic impairment of orthostatic adaptation is the only noteworthy change. Microrecording studies will make it possible to better identify the target site. Neuroimaging investigations have shown that hypothalamic stimulation activates ipsilateral trigeminal complex, but with no immediate perceived sensation within the trigeminal distribution. Other studies on the pain threshold in chronically stimulated patients showed increased threshold for cold pain in the distribution of the first trigeminal branch ipsilateral to stimulation. These studies suggest that activation of the hypothalamus and of the trigeminal system are both necessary, but not sufficient to generate CH attacks. IN ADDITION TO THE HYPOTHALAMUS, OTHER UNKNOWN BRAIN AREAS ARE LIKELY TO PLAY A ROLE IN THE PATHOPHYSIOLOGY OF THIS ILLNESS. HYPOTHALAMUS IMPLANTATION IS ASSOCIATED WITH A SMALL RISK OF INTRACEREBRAL HAEMORRHAGE AND MUST BE PERFORMED BY AN EXPERT NEUROSURGICAL TEAM, IN SELECTED PATIENTS.
PMID: 21179610 [PubMed] ======= Prog Neurol Surg. 2011;24:126-32. Epub 2011 Mar 21. Peripheral nerve stimulation in chronic cluster headache. Magis D, Schoenen J. SourceHeadache Research Unit, University Department of Neurology, CHR Citadelle, Liège, Belgium.
Abstract Cluster headache is well known as one of the most painful primary neurovascular headache. Since 1% of chronic cluster headache patients become refractory to all existing pharmacological treatments, various invasive and sometimes mutilating procedures have been tempted in the last decades. Recently, neurostimulation methods have raised new hope for drug-resistant chronic cluster headache patients. The main focus of this chapter is on stimulation of the great occipital nerve, which has been the best evaluated peripheral nerve stimulation technique in drug-resistant chronic cluster headache, providing the most convincing results so far. Other peripheral nerve stimulation approaches used for this indication are also reviewed in detail. Although available studies are limited to a relatively small number of patients and placebo-controlled trials are lacking, existent clinical data suggest that occipital nerve stimulation should nonetheless be recommended for intractable chronic cluster headache patients before more invasive deep brain stimulation surgery. More studies are needed to evaluate the usefulness of supraorbital nerve stimulation and of vagus nerve stimulation in management of cluster headaches.
Copyright © 2011 S. Karger AG, Basel.
PMID:21422783[PubMed]
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