![]() Cluster headache attacks may also occur with clocklike regularity during the day and may be precipitated by sleep, 3 usually occurring 90 minutes after the onset of sleep. 2 Chronic cluster headache is defined as occurring for more than a year without remission or with remissions lasting less than a month. Bouts are usually circannual, occurring once a year, with a mean bout duration of 8 weeks. Episodic cluster headache is defined as bouts of attacks lasting 7 days up to a year with breaks of 1 month or more between bouts. 1Īttacks usually occur in bouts, or clusters, lasting for weeks or months, separated by remissions lasting months or years. Attacks typically last for 15 to 180 minutes untreated and have a frequency of 1 every other day for up to 8 attacks a day. During attacks patients are often restless, agitated, or both. Trial Registration Identifier: ISRCTN94092997Ĭluster headache is a stereotypical primary headache syndrome characterized by attacks of unilateral excruciating pain usually in the eye, periorbital region, and temple with associated cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal blockage, rhinorrhea, ptosis, and eyelid edema. There were no important adverse events.Ĭonclusion Treatment of patients with cluster headache at symptom onset using inhaled high-flow oxygen compared with placebo was more likely to result in being pain-free at 15 minutes. For the primary end point the difference between oxygen, 78% (95% confidence interval, 71%-85% for 150 attacks) and air, 20% (95% confidence interval, 14%-26% for 148 attacks) was significant (Wald test, χ 2 5 = 66.7, P < .001). Results Fifty-seven patients with episodic cluster headache and 19 with chronic cluster headache were available for the analysis. ![]() Secondary end points included rendering the patient pain free at 30 minutes, reduction in pain up to 60 minutes, need for rescue medication 15 minutes after treatment, overall response to the treatment and overall functional disability, and effect on associated symptoms. Main Outcome Measures The primary end point was to render the patient pain free, or in the absence of a diary to have adequate relief, at 15 minutes. Intervention Inhaled oxygen at 100%, 12 L/min, delivered by face mask, for 15 minutes at the start of an attack of cluster headache or high-flow air placebo delivered alternately for 4 attacks. Patients were recruited and followed up between 20 at the National Hospital for Neurology and Neurosurgery, London, England. Patients were randomized to the order in which they received the active treatment or placebo. Patients treated 4 headache episodes with high-flow inhaled oxygen or placebo, alternately. Objective To ascertain whether high-flow inhaled oxygen was superior to placebo in the acute treatment of cluster headache.ĭesign, Setting, and Patients A double-blind, randomized, placebo-controlled crossover trial of 109 adults (aged 18-70 years) with cluster headache as defined by the International Headache Society. The current licensed treatment for acute attacks is subcutaneous sumatriptan. Shared Decision Making and CommunicationĬontext Cluster headache is an excruciatingly painful primary headache syndrome, with attacks of unilateral pain and cranial autonomic symptoms.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment. ![]() Clinical Implications of Basic Neuroscience. ![]() Challenges in Clinical Electrocardiography. ![]()
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