Bob Johnson
CH.com Alumnus
 
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"Only the educated are free." -Epictetus
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Kennett Square, PA (USA)
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I trust that a specialist has considered a Cluser-LIKE picture.
Link to: cluster-LIKE headache:
IN: "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache" ====== New abotive not yet studied but worth considering. Cephalalgia. 2014 Mar 24.
Complete alleviation of treatment refractory primary SUNCT syndrome with clomiphene citrate (a medicinal deep brain hypothalamic modulator). Rozen TD. Author information Geisinger Health System, Department of Neurology, Geisinger Headache Clinic, PA, USA. Abstract OBJECTIVE: To report the first ever case of primary short-lasting unilateral neuralgiform headache attacks (SUNCT) syndrome completely responsive to clomiphene citrate.
METHODS: Case report.
RESULTS: SUNCT is a primary headache disorder marked by frequent attacks of one-sided headache with cranial autonomic associated symptoms. When SUNCT is deemed medicinally treatment refractory, it can cause tremendous patient-related disability. Surgical treatment options are available including hypothalamic deep brain stimulation, occipital nerve stimulator placement or arterial decompression surgery, but these procedures carry significant morbidity. A patient presented with a 10 month complaint of multiple, daily short-lasting, right-sided headaches each lasting from 60 to 120 seconds in duration and occurring from 100 to 200 times per day. The head pain was associated with ipsilateral eyelid ptosis and conjunctival injection. The patient was diagnosed with SUNCT but was unresponsive to multiple recognized medicinal treatments. He had complete alleviation of his attacks with clomiphene citrate, a synthetic, non-steroidal, ovulatory stimulant that directly binds to hypothalamic estrogen receptors. The clomiphene was tolerated without any adverse events. A putative mechanism of action for clomiphene in the prevention of SUNCT will be presented.
CONCLUSION: Clomiphene citrate is a unique treatment for SUNCT and appears to be very safe and effective.
KEYWORDS: Clomiphene citrate, SUNCT, cluster headache, estrogen, hypocretin, hypothalamus, orexin
PMID:24662321[PubMed] ***** The full text article mentioned in passing that this had worked on Cluster but no details. But author always catches my attention. ==== ==== Has been my favorite since this article appeared. Convenience of a pill (re. your work) and 1-3 trials should give you some idea of effectiveness. -- 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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