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: