CLUSTER HEADACHE
OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF HEADACHE
CLUSTER HEADACHE EDITED BY NINAN 1. MATHEW, M.D. DIRECTOR, HOUSTON HEADACHE CLINIC AND DEPARTMENT OF NEUROLOGY UNIVERSITY OF TEXAS MEDICAL SCHOOL HOUSTON, TEXAS MT~L1MITED International Medical Publishers
Published in the UK and Europe by MTP Press Limited Falcon House Lancaster, England Published in the US by SPECTRUM PUBLICATIONS, INC. 175-20 Wexford Terrace Jamaica, NY 11432 Copyright 1984 by Spectrum Publications, Inc. Softcover reprint of the hardcover 1st edition 1984 All rights reserved. No part of this book may be reproduced in any form, by photostat, microfilm, retrieval system, or any other means without prior written permission of the copyright holder or his licensee. ISBN-13: 978-94-011-7824-2 e-isbn-13: 978-94-011-7822-8 DOl: 10.1 007/978-94-011-7822-8
Contributors J. Keith Campbell, MD Department of Neurology, Mayo Clinic, 'Rochester, Minnesota James R. Couch, Jr., MD Chief, Division of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois Donald J. Dalessio, MD Chairman, Department of Medicine, Scripps Clinical Medical Group, Inc., La Jolla, California James D. Dexter, MD. Chairman, Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri Seymour Diamond, MD Department of Pharmacology, Chicago Medical School; Director, Diamond Headache Clinic, Chicago, Illinois John Edmeads, MD Chief of Neurology, Sunnybrook Medical Center; President, American Association for the Study of Headache, Toronto, Ontario Arnold P. Friedman, MD Department of Neurology, University of Arizona School of Medicine, Tuscon, Arizona John R. Graham, MD Director, Headache Research Foundation, Faulkner Hospital, Boston, Massachusetts Robert S. Kunkel, MD The Cleveland Clinic Foundation, Cleveland, Ohio v
vi Contributors Ninan T. Mathew, MD Director, Houston Headache Clinic; Department of Neurology, University of Texas Medical School, Houston, Texas Joel R. Saper, MD Department of Neurology, Michigan State University Medical School; Director, Michigan Headache and Neurological Institute, Ann Arbor, Michigan William G. Speed III, MD Department of Medicine, Johns Hopkins University Medical School; Speed Headache Associates, Baltimore, Maryland N. Vijayan, MD Sacramento Headache and Neurology Clinic, Sacramento, California Craig Watson, MD, PhD. Sacramento Headache and Neurology Clinic, Sacramento, California.
Foreword This book constitutes a compilation and integration of the latest advances in the management of cluster headaches. It encompasses the work of nine experts in the field of headache in the U.S. and presents a thorough and comprehensive view of the subject. Most of the participants at the symposium have spent years studying cluster headache and its variants. They present a variety of conceptions in a comprehensive manner. It is believed that the generalist, neurologist, or other medical specialist involved in the treatment of this difficult syndrome will derive diagnostic and therapeutic insight into its management. The patients seeking help and understanding of their condition will be the ultimate beneficiaries of its information. SEYMOUR DIAMOND, M.D. March, 1984
Preface The past decade has witnessed a surge of interest in the field of headache and related disorders. Even though the pathophysiology and pathogenesis of primary headache disorders are still poorly understood, recent clinical and therapeutic observations have greatly contributed to improvement of patient care in the headache field. Headache clinics specializing in the diagnosis and comprehensive management of headaches, now available in most major cities, have also helped in the progress of patient care and research. Cluster headache, being one of the most severe forms of headache and probably the most "pure" form of headache, deserves special attention. The American Association for the Study of Headache has planned a series of advanced courses in certain aspects of headache and chose cluster headache as the first topic to be discussed. In this advanced course, the faculty was selected because of their special experience in treating cluster headaches and their wider experience in the field of headache research and therapy. This monograph is an outgrowth of that course. Historical aspects of cluster headache are very adequately dealt with by Dr. William Speed. John Graham has painstakingly compared migraine and cluster headache and brought out their differences and similarities. The section on therapy is dealt with by physicians who have firsthand experience in treating a large number of patients with cluster headache, and who are also researchers in that particular aspect of the disease. The controversial treatments like histamine desensitization is dealt with by a respected member of the Neurology Department of the Mayo Clinic, where this form of treatment originated years ago. ix
x Preface Overall, this book gives a balanced view of a number of specialists in the field rather than a fixed view of one individual author, and is the first of a series on various aspects of headache. Ninan T. Mathew, M.D.
Contents Contributors Foreword Preface Chapter 1 History, Nomenclature, Relation to Other Facial Pain Syndromes William G. Speed III Chapter 2 Classification of Cluster Headache: Clinical Features of Episodic Cluster Headache Robert S. Kunkel Chapter 3 Variants of Cluster Headache Seymour Diamond v vii ix 1 15 21 Chapter 4 Nonheadache Disorders and Characteristics of Cluster Headache Patients 31 Joel R. Saper Chapter 5 Peripheral Autonomic Abnormalities in Cluster Headache 45 N. Vijayan and Craig Watson xi
xii Chapter 6 Pathyphysiologic Aspects of Cluster Headache John Edmeads Chapter 7 Cycles in Cluster Headache James D. Dexter Chapter 8 The Psychological and Behavioral Aspects of the Cluster Headache Patient Arnold P. Friedman Chapter 9 The Relation of Cluster Headache to Migraine John R. Graham Chapter 10 Treatment and Management of Acute Cluster Headache James R. Couch, Jr. Chapter 11 Prophylactic Pharmacotherapy of Cluster Headache Ninan T. Mathew Chaper 12 The Current Status of Histamine Desensitization in the Treatment of Cluster Headache J. Keith Campbell Chapter 13 Surgical Therapy of Cluster Headache Donald J. Dalessio Chapter 14 Cluster Headache: The Treatment-Resistant Patient J. Keith Campbell Index Contents 57 69 73 79 89 97 111 119 127 135
CLUSTER HEADACHE