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Posted by Ted ( on September 17, 2000 at 11:34:47:

In Reply to: O2 Question posted by Frank Ford on September 16, 2000 at 18:08:33:

HTML1DocumentEncodingutf-8Cephalalgia 1995 Oct;15 Suppl 15:33-6
Treatment of cluster headache: clinical trials, design and results.
Ekbom K
Department of Neurology, Soder Hospital, Stockholm, Sweden.
The spontaneous capricious course of cluster headache may give rise to some problems
when treatment is being evaluated. This is one of several explanations for there being so
few well-designed, randomized, double-blind clinical trials in cluster headache. The
standard treatment of acute attacks of cluster headache is inhalation of 100% oxygen. In
the prophylaxis of episodic cluster headache, ergotamine, verapamil, lithium, serotonin,
inhibitors and steroids are used. In chronic cluster, lithium is the drug of choice, but
verapamil may also be tried. Recently, hyperbaric oxygen has been shown to immediately
abort acute attacks, and it seems that it may also be useful in the prophylactic treatment.
The introduction of the novel 5HT1 agonist sumatriptan as a symptomatic relief of cluster
attacks represents further significant progress. Two randomized, double-blind,
placebo-controlled, cross-over trials have shown sumatriptan 6 mg sc to be a rapid,
effective and well-tolerated acute treatment for cluster headache attacks. Within 15 min
of treatment, 74% of attacks on sumatriptan responded compared to 26% of
placebo-treated attacks. Functional disability was also significantly improved. Increasing
the dose to 12 mg did not offer significantly greater relief compared to sumatriptan 6 mg,
but was associated with an increased incidence of adverse events. Interim analysis of 3
months of data from a recent multinational open trial comprising, 138 patients having
treated 6353 attacks with subcutaneous sumatriptan 6 mg revealed a headache relief in
96% of attacks treated. There was no evidence of an increased incidence of adverse
events with frequent use of sumatriptan. No tachyphylaxis was seen over the 3 months,
suggesting that sumatriptan is effective and well tolerated also in long-term acute
treatment for cluster headache.
Publication Types:
Review, tutorial
PMID: 8749244, UI: 96356345

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HTML1DocumentEncodingutf-8J Pain Symptom Manage 1993 Apr;8(3):155-64
Diagnosis and treatment of cluster headache.
Campbell JK
Cluster headache (CH) is a rare form of headache occurring in both episodic and chronic
forms. The painful attacks are short-lived, occur unilaterally, and are associated with
signs and symptoms of autonomic involvement. Attacks frequently occur at night and can
be precipitated by ingestion of alcohol. In the episodic form, attacks occur daily for some
weeks followed by a period of remission. In the chronic form, attacks can continue for
years. Inheritance is not a factor in CH. Treatment can be symptomatic or prophylactic.
Agents used to treat individual attacks include inhalation of oxygen, rapidly acting forms
of ergotamine and dihydroergotamine, and sumatriptan. Prophylactic treatment employs
calcium-channel-blocking agents, methysergide, lithium, and corticosteroids. Surgical
modalities, notably thermocoagulation of the gasserian ganglion, can provide relief in
those who are resistant to medical management.
Comment in: J Pain Symptom Manage 1994 Jan;9(1):4
PMID: 8326166, UI: 93315909

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Headache 1996 Feb;36(2):105-7
Analgesic use in cluster headache.
Gallagher RM, Mueller L, Ciervo CA
University Headache Center, University of Medicine & Dentistry of New Jersey,
Moorestown 08057, USA.
Cluster headache is a brutal affliction characterized by excruciating pain with relatively
brief, but frequent attacks. Because of the short duration of the attacks and the
tremendous intensity of pain, symptomatic analgesics are often not effective. However,
inhalation oxygen, while being cumbersome, is reported to be effective in the majority of
sufferers. To assess the practical effectiveness and use of analgesics and/or oxygen, a
review of 60 cluster patients was conducted. At initial evaluation, 48 patients had
accepted oral analgesics and 51 patients accepted inhalation oxygen for breakthrough
headaches. After acceptable prophylactic treatment was established, 65% of patients who
accepted analgesics continued their use, although most reported only minimal relief. Only
31% of patients who accepted oxygen continued its use, in spite of the fact that most
sufferers reported significant relief. From this brief study, it appears that cluster headache
patients prefer to use analgesics for reasons that are not solely for relief of pain, and that
patients decline the use of oxygen for reasons other than lack of effectiveness.
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Arch Neurol 1985 Apr;42(4):362-3

Treatment of cluster headache. A double-blind comparison of oxygen v air

Fogan L

Nineteen men, aged 20 to 50 years, were treated in a double-blind crossover
study comparing oxygen v air inhalation at 6 L/min via nonrebreathing face
masks for 15 minutes or less, for up to six headaches. Patients scored their
own degree of relief for each treatment as none, slight, substantial, or
complete relief. The average (+/- SE) relief score for all oxygen-treated
patients was 1.93 +/- 0.22 out of a possible total score of 3.0, and for air
the treatment relief score was 0.77 +/- 0.23. This difference is highly
statistically significant by an analysis-of-variance F test; it documents that
patients with cluster headache can benefit from oxygen inhalation during acute

Publication Types:
Clinical trial
Controlled clinical trial

PMID: 3885921, UI: 85173916

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Nervenarzt 1986 May;57(5):311-3
[Cluster headache and chronic paroxysmal hemicrania--effectiveness of oxygen
[Article in German]
Heckl RW
Ten patients suffering from cluster headache or variants of cluster headache were made to
inhale oxygen in an attempt to check these attacks. This treatment proved a success with
six patients with classic ("episodic") cluster headache, as well as with another patient
suffering from secondary chronic cluster headache. One patient with primary chronic
cluster headache and another with chronic paroxysmal hemicrania (PCH) experienced
only temporary relief and a female patient with PHC showed no reaction to oxygen
inhalation. The patient who suffered from secondary chronic cluster headache has had no
further attacks in the four years following this treatment.
PMID: 3724924, UI: 86257570
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