670 Antimigraine Drugs Antimigraine Drugs periods. Other drugs under investigation include gabapen- 4. Anonymous. Management of medication overuse headache. Drug Ther Bull Cluster headache, p. 670 tin, melatonin, and topiramate.4,9-11,13 2010; 48: 2–6. 5. Bigal ME, Lipton RB. Excessive acute migraine medication use and Medication-overuse headache, p. 670 Paroxysmal hemicrania is a rare variant of cluster migraine progression. Neurology 2008; 71: 1821–8. Migraine, p. 670 headache and differs mainly in the high frequency and 6. British Association for the Study of Headache. Guidelines for all Post-dural puncture headache, p. 671 shorter duration of individual attacks. One of its features, healthcare professionals in the diagnosis and management of migraine, which may be diagnostic, is its invariable response to tension-type, cluster and medication-overuse headache. 3rd edn. Tension-type headache, p. 671 (issued 18th January, 2007; 1st revision, September 2010). Available at: 10 indometacin. http://217.174.249.183/upload/NS_BASH/2010_BASH_Guidelines.pdf 1. Dodick DW, Capobianco DJ. Treatment and management of cluster (accessed 01/12/10) headache. Curr Pain Headache Rep 2001; 5: 83–91. 7. Scottish Intercollegiate Guidelines Network. Diagnosis and management This chapter reviews the management of headache, in 2. Zakrzewska JM. Cluster headache: review of literature. Br J Oral of headache in adults (issued November 2008). Available at: http:// particular migraine and cluster headache, and the drugs Maxillofac Surg 2001; 39: 103–13. www.sign.ac.uk/pdf/sign107.pdf (accessed 26/01/09) Drug Safety used mainly for their treatment. The mechanisms of head 3. Ekbom K, Hardebo JE. Cluster headache: aetiology, diagnosis and 8. Silberstein SD, Young WB. Analgesic rebound headache. management. Drugs 2002; 62: 61–9. 1995; 13: 133–44. pain or headache are not fully understood but may involve 4. Matharu MS, et al. 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A new cluster headache precipitant: increased body paradoxically, those used to treat it. The International heat. Lancet 1999; 354: 1001–2. that typically last 4 to 72 hours. Attacks persisting for longer Headache Society has published guidelines to aid the 8. Scottish Intercollegiate Guidelines Network. Diagnosis and management than 72 hours are referred to as status migrainosus. The of headache in adults (issued November 2008). Available at: http:// diagnosis of the various headache types. Patients may have headache is usually a unilateral pulsating pain that is www.sign.ac.uk/pdf/sign107.pdf (accessed 26/01/09) aggravated by movement and is usually of sufficient severity more than one headache disorder simultaneously and 9. Halker R, et al. Cluster headache: diagnosis and treatment. Semin Neurol require separate treatment for each. 2010; 30: 175–85. to disturb or prevent daily activities. It is frequently Martindale10. Evers S, et al. 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Cluster headache—acute and prophylactic follows the aura directly, or within 1 hour, but may begin Headache therapy. 2011; 51: 272–86. simultaneously with the aura. In addition, aura can occur Sample12. British Association for the Study of Headache. Guidelines for all Cluster headache healthcare professionals in the diagnosis and management of migraine, without headache. Migraine without aura (common ..................................................................................................... tension-type, cluster and medication-overuse headache. 3rd edn. migraine) is the more common form occurring in about Cluster headache (migrainous neuralgia, histaminic (issued 18th January, 2007; 1st revision, September 2010). Available at: 75% of patients with migraine. Premonitory symptoms may cephalalgia, Horton’s syndrome) is of unknown aetiology http://217.174.249.183/upload/NS_BASH/2010_BASH_Guidelines.pdf occur before a migraine attack (with or without aura). (accessed 01/12/10) 1-5 but may be neurovascular in origin. Patients have one or 13. Francis GJ, et al. Acute and preventive pharmacologic treatment of Familial hemiplegic migraine is a rare syndrome in which more short-lived attacks of intense unilateral head pain, cluster headache. Neurology 2010; 75: 463–73. migraine with aura may be preceded or accompanied by usually at the same time of day (often at night). These are dysphasia, confusion, and hemiparesis. Basilar-type associated with autonomic symptoms such as conjunctival Medication-overuse headache migraine is another rare form of migraine with aura in injection or lachrymation, miosis or ptosis, nasal congestion ..................................................................................................... which there may be disturbances of the brain stem or or rhinorrhoea, forehead or facial sweating, and eyelid Overuse of drugs such as ergotamine, triptans, and occipital lobes accompanied by symptoms such as decreased oedema. Restlessness during the attacks is characteristic. analgesics (including opioids and combination preparations level of consciousness, vertigo, ataxia, dysarthria, and The period during which attacks occur is called a cluster containing caffeine or butalbital) to treat headache or diplopia. period; it may last several weeks or months. In the typical migraine can lead to dependence and paradoxical chronic Migraine is described as a neurovascular headache. 1-5 episodic form of cluster headache, cluster periods are daily headache in headache-prone patients. Such Traditionally, intracranial vasoconstriction was considered followed by periods of remission lasting for months or years headaches do not appear to occur with regular use of responsible for the aura and extracranial vasodilatation for but in the more rare chronic form, patients may have cluster analgesics to treat other disorders except occasionally in the headache. However, it appears that vascular events may 1 periods lasting for more than a year, or with short periods of patients with a history of migraine. Medication-overuse be secondary to neuropathic changes and the liberation of remission in between. Substances such as alcohol, headaches, also referred to as rebound, analgesic abuse, or vasoactive substances including serotonin (5-HT), catecho- histamine, or glyceryl trinitrate can precipitate headache analgesic-induced headaches, can be difficult to treat and lamines, histamine, kinins, neuropeptides such as calcitonin attacks during cluster periods, but not during periods of are relieved by withdrawal ofpages the offending drug, but the gene-related peptide (CGRP), and prostaglandins. remission. There is speculation that sleep-disordered primary headache may still persist and revert to its previous There are several factors that may precipitate migraine breathing6 and increased body heat7 may also trigger pattern of occurrence. Furthermore, stopping abruptly can attacks. These include anxiety, physical and emotional cluster headaches. exacerbate headache and produce other symptoms of stress, a change in sleep pattern, bright lights, fasting, some The treatment of individual acute attacks during a withdrawal. This may then lead the patient to resume foods, and menstruation. Menstrual migraine is charac- cluster period is difficult because the headache is short-lived treatment to relieve the headache thereby setting up a terised by attacks without aura which are most likely to and oral analgesics are unlikely to be absorbed fast enough vicious circle. occur within 2 days of the start of menstruation. Migraine to produce much benefit.1,3,4 Inhalation of 100% oxygen Options for outpatient treatment include either abrupt may also be precipitated by drugs including combined oral should be considered in all patients.8-11 It is rapid and or