Chapter 12 Cluster and other trigeminal autonomic cephalalgias
Gennaro Bussone and
Massimo Leone
- • The first step in management is to reassure the patient that the condition is benign and to provide accurate information about it.
- • There are two pharmacological approaches: acute and prophylactic.
- • For cluster headache, the first choice acute treatment is the selective 5-HT1B/1D receptor agonist sumatriptan.
- • A number of different drug options are available for prophylaxis.
- • The choice of prophylactic drug is influenced by previous response, previous side-effects, contraindications, duration of symptoms, and the age and lifestyle of the patient.
- • If a severe attack occurs notwithstanding prophylaxis, acute medications should be employed.
- • Patients with chronic trigeminal autonomic cephalalgias who do not respond to, or have major contraindications to, prophylactic treatments may be candidates for surgical approaches.
