Posted by Dr. Gary A. Mellick on August 25, 1998 at 23:59:16:
In Reply to: Re: Update on Cluster Headaches and Ritalin Therapy posted by irene on August 25, 1998 at 21:00:40:
irene,
Here are a number of medical abstracts that I have on file that address some of your questions.
I hope you have a successful trip to Mayo's Headache Clinic. I think you will meet some of the most intelligent, capable, and understanding docs in the world. Please post your experiences when you return.
Good Luck,
Dr. Gary A. Mellick
Medical Abstracts:
Headache 1997 Jun;37(6):377-382
Droperidol treatment of status migrainosus and refractory migraine.
Wang SJ, Silberstein SD, Young WB
Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
We conducted a pilot study of intravenous droperidol in 35 patients (32 women and 3 men; mean age 43 years) with status migrainosus (n = 25) or refractory migraine (n = 10) in an ambulatory infusion center. Headache was graded as severe in 21 patients and moderate in 14. An intravenous line was started and kept open. Droperidol (2.5 mg) was given intravenously every 30 minutes until either three doses were given or the patient was completely or almost headache-free prior to the next dose. Seven patients received one dose, 12 received two doses, and 16, three doses (mean 5.6 mg). Our success rate (headache-free or mild headache) was 88% (22 of 25) in patients with status migrainosus and 100% (10 of 10) in patients with refractory migraine. The average time to headache improvement was 40 minutes (n = 35), to mild headache--60 minutes (n = 32), and to headache-free--105 minutes (n = 28). Nausea, vomiting, and light and sound sensitivity resolved in all but 5 patients. Four patients had an asymptomatic systolic blood pressure drop > or = 20 mm Hg. Most patients were sedated (34 of 35). Five patients developed akathisia and 1 dystonia. At follow-up 24 hours after discharge, the recurrence rate (headache intensity from none or mild to moderate or severe) was 23% in status migrainosus and 10% in refractory migraine. Twenty-one patients were sedated, while 19 had extrapyramidal symptoms, mainly restlessness. Droperidol is effective and safe in treating status migrainosus or refractory migraine. Hypotension was uncommon. Patients should be warned of sedation and akathisia.
Headache 1997 Apr;37(4):256-257
Treatment of acute migraine with intravenous droperidol.
Rothrock JF Publication Types:Letter
Headache 1996 Jul;36(7):429-432
Alternatives in drug treatment of chronic paroxysmal hemicrania.
Evers S, Husstedt IW
Department of Neurology, University of Munster, Germany.
Indomethacin is the drug of first choice in chronic paroxysmal hemicrania with clear relief of pain as a diagnostic criterion. In a few cases, indomethacin is not tolerated because of side effects. Therefore, the efficacy of carbamazepine, verapamil, sumatriptan, acetylsalicylic acid, and oxygen as drugs in the prophylactic or acute treatment of chronic paroxysmal hemicrania was studied in a prospective open trial with 10 patients suffering from chronic paroxysmal hemicrania. The trial results, in accordance with a review of the literature, suggest that acetylsalicylic acid (and probably naproxen and diclofenac) and verapamil are the most effective drugs of second choice in chronic paroxysmal hemicrania. The efficacy of sumatriptan in this condition needs still to be clarified, although there is evidence for partial efficacy. Carbamazepine and oxygen did not show any significant influence on chronic paroxysmal hemicrania.
Curr Opin Neurol 1995 Jun;8(3):243-247
Treatment of cluster headache and its variants.
Stovner LJ, Sjaastad O
Department of Neurology, Trondheim University Hospital, Norway.
In cluster headache, subcutaneous administration of sumatriptan has been established as an efficient, safe and well tolerated treatment for acute attacks. For prophylactic treatment, capsaicin (intranasal administration) and leuprolide (a synthetic slow-release gonadotrophin-releasing hormone) seem to be promising. Hyperbaric oxygen therapy seems to be effective in acute attacks, but it is of interest mostly because of its apparent interruption of the cluster period in some patients. In chronic paroxysmal hemicrania, which clinically resembles cluster headache, indomethacin is still necessary for diagnosis, and it is the treatment of choice in most patients. However, because of its potential side effects, alternative treatments should be sought.
Int J Oral Maxillofac Surg 1987 Feb;16(1):25-35
Vasogenic facial pain (cluster headache).
Eversole LR, Stone CE
8 cases of vasogenic facial pain are presented with delineation of differentiating clinical features. These vasogenic syndromes include classic episodic cluster headache, chronic cluster headache, and indomethacin responsive chronic cluster headache. Open clinical trials employing inhalation O2 therapy as an abortive treatment strategy utilized in combination with prophylactic nifedipine therapy proved highly efficacious in controlling pain among most classic and chronic cluster headaches. A single case of chronic paroxysmal hemicrania responded favorably to indomethacin.
Nervenarzt 1986 May;57(5):311-313
[Cluster headache and chronic paroxysmal hemicrania--effectiveness ofoxygen inhalation]. [Article in German]
Heckl RW
Ten patients suffering from cluster headache or variants of cluster headache were made to inhale oxygen in an attempt to check these attacks. This treatment proved a success with six patients with classic ("episodic") cluster headache, as well as with another patient suffering from secondary chronic cluster headache. One patient with primary chronic cluster headache and another with chronic paroxysmal hemicrania (PCH) experienced only temporary relief and a female patient with PHC showed no reaction to oxygen inhalation. The patient who suffered from secondary chronic cluster headache has had no further attacks in the four years following this treatment.
I hope these help.
Dr. Gary A. Mellick