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Suggest Treatment For Chronic Headaches
Question: My 32 year old son has cluster headaches for the past 3 years and nothing seems to be helping. He has them for about 3 months and then they go away for 1 1/2 years. Has been on Topamax in past but this time its not helping. He has no insurance at this time and l have been paying cash for any treatment. I heard about place in Arizona using topical anesthetic to numb trigeminal nerve. Anyone in Michigan area doing this? or any other options?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern about your son.
I was at first a little reluctant to answer as I exercise in Europe so not that confident about making recommendations about Michigan (although I would recommend the XXXXXXX Arbor University of Michigan Hospitals and Health Centers, as a widely recognized center I believe it should offer procedures involving trigeminal rhizotomy).
However I decided to answer because reading at the therapeutic options you have tried it seems you haven't exhausted your options, actually you haven't used the most common treatments. Procedures like trigeminal rhizotomy are indicated only when therapy has failed, so it isn't recommended at this point.
Cluster headache management involves aborting the attacks and preventive treatment. To abort the attacks the most used options are high concentration oxygen administration as well as triptans (sumatriptan in subcutaneous injections the most used) or dihydroergotamine.
When it comes to preventive treatment, Topamax is used at times, but it isn't the most common first line option, not the first to be recommended. The most common class used for prevention of cluster headaches are calcium channel blockers, with Verapamil as the most studied and proven option. It is used in high dosages of 120 to 160 mg three times daily (total of 360-480 mg/d). It needs some time and achieves a reduction in frequency of attacks in about 2 weeks.
The other commonly used option is Prednisone. It is started with a high dosage of about 50 - 80 mg per day for the first few days, then tapered gradually over about two weeks. Its effect is felt right from the first few days. So it is commonly used together with Verapamil with the corticosteroid acting sooner and then leaving its place to Verapamil.
Other options apart from Verapamil may include Lithium, Valproic acid, Gabapentine.
Procedures like percutaneous RF ablation, trigeminal gangliorhizolysis, and rhizotomy etc are used only when therapy fails and they do not work in all patients.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern about your son.
I was at first a little reluctant to answer as I exercise in Europe so not that confident about making recommendations about Michigan (although I would recommend the XXXXXXX Arbor University of Michigan Hospitals and Health Centers, as a widely recognized center I believe it should offer procedures involving trigeminal rhizotomy).
However I decided to answer because reading at the therapeutic options you have tried it seems you haven't exhausted your options, actually you haven't used the most common treatments. Procedures like trigeminal rhizotomy are indicated only when therapy has failed, so it isn't recommended at this point.
Cluster headache management involves aborting the attacks and preventive treatment. To abort the attacks the most used options are high concentration oxygen administration as well as triptans (sumatriptan in subcutaneous injections the most used) or dihydroergotamine.
When it comes to preventive treatment, Topamax is used at times, but it isn't the most common first line option, not the first to be recommended. The most common class used for prevention of cluster headaches are calcium channel blockers, with Verapamil as the most studied and proven option. It is used in high dosages of 120 to 160 mg three times daily (total of 360-480 mg/d). It needs some time and achieves a reduction in frequency of attacks in about 2 weeks.
The other commonly used option is Prednisone. It is started with a high dosage of about 50 - 80 mg per day for the first few days, then tapered gradually over about two weeks. Its effect is felt right from the first few days. So it is commonly used together with Verapamil with the corticosteroid acting sooner and then leaving its place to Verapamil.
Other options apart from Verapamil may include Lithium, Valproic acid, Gabapentine.
Procedures like percutaneous RF ablation, trigeminal gangliorhizolysis, and rhizotomy etc are used only when therapy fails and they do not work in all patients.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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