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Suggest Treatment For Cluster Headache

Posted on Wed, 18 May 2016

Question: My sister is 51 years old. Since she was 20's she suffered from intermittent attacks of migraine and she used to respond by the normal Imigran and similar medicine. In a severe attack few years ago she ran a brain CT and it proved normal.
It has been a complete week now and she is unprecedently suffering from very severe headache attacks to the extent that the pain wakes her up in the middle of sleeping 3:00 or 4:00 am
All pain killers, imigran, and other similar medicine do very little qnd the attack revisits daily.
She was subjected to brain MRI with pigment and it proved normal.
The doctor diagnosed he for the so called "cluster headache" and thus prescription was as follows:
Imigran 100 mg
Convipan twice daily
Lornoxicam 8mg twice daily
Estikan 20 mg
Tegretol 200 ( single dose to prevent the attack and 2x200 when attacked )

I need you assessment of the such condition and the list of medicine.
We could get the Immigran Nasal sparay 10mg... could it replace the 100mg pills?
Any risk of addiction or life threatening in these medicines
The doctor here said that after 2 weeks if the case persists, we might have to "kill" a nerve in the head by injection!!!
Pls advise

Answered by Dr. Ajay Panwar (32 minutes later)

Brief Answer:
Nasal spray can be taken during the acute headache episode.

Detailed Answer:
Hi XXXXXXX gaawan,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have read through your sister's detailed clinical history.
Of course,the diagnosis can be cluster headache.MRI being normal,has almost ruled out secondary causes of headache.So,high chances are that it is primary headache.Cluster headache are well known to awaken the patient from sleep.

Let me know a few details-
1)How many episodes of headache she has in a day?At what time of the day,she have them often?
2)What is the duration of each episode?
3)Does the headache accompany unilateral lacrimation,redness of eye or nasal stuffiness?Is the headache unilateral?
4)Does the headache episodes cluster themselves in any particular season/time of the year?
5)How much time does it take for the headache to peak?

Yes,imigran 10 mg nasal spray can be used in acute events instead of 100 mg pill.10 mg spray however may not suffice and 20 mg may have to be used.

No serious addiction or life threatening risk with these medicines.

Your treating doctor is probably talking about neurostimulation. Neurostimulation is used in cluster headache,if headache treatment does not respond to medicines.

Hope that helps.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (38 minutes later)

Thx. Pls find below reply to your five questions

1) 3 episodes a day, usually at noon, at sunset, and XXXXXXX
2) An hour to 90 mins.
3)Yes. Mostly at the left side, but sometimes the pain involves the whole head.
4) During spring and summer.
5) It's usually at its peak at XXXXXXX it lasts for thirty minutes.

Answered by Dr. Ajay Panwar (2 hours later)

Brief Answer:
Appears to be cluster headache

Detailed Answer:
Hi XXXXXXX gaawan,
Thanks for being in follow-up.

In view of the clinical details,you have provided-cluster headache appears to be the most likely diagnosis.

I suggest you to continue the medicines which you have listed above.They are appropriate for the clinical situation.

If you have any further questions,I shall be glad to answer them.

Regards
Dr.Ajay Panwar
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar