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The Usual Treatment of Trigeminal Autonomic Cephalalgias
Author(s) -
Pareja Juan A.,
Álvarez Mónica
Publication year - 2013
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12193
Subject(s) - medicine , sumatriptan , anesthesia , cluster headache , topiramate , lamotrigine , zolmitriptan , flunarizine , migraine , epilepsy , agonist , receptor , psychiatry , calcium
Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, and short‐lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, and rhinorrhea ( SUNCT ). Conventional pharmacological therapy can be successful in the majority of trigeminal autonomic cephalalgias patients. Most cluster headache attacks respond to 100% oxygen inhalation, or 6 mg subcutaneous sumatriptan. Nasal spray of sumatriptan (20 mg) or zolmitriptan (5 mg) are recommended as second choice. The bouts can be brought under control by a short course of corticosteroids (oral prednisone: 60‐100 mg/day, or intravenous methylprednisolone: 250‐500 mg/day, for 5 days, followed by tapering off the dosage), or by long‐term prophylaxis with verapamil (at least 240 mg/day). Alternative long‐term preventive medications include lithium carbonate (800‐1600 mg/day), methylergonovine (0.4‐1.2 mg/day), and topiramate (100‐200 mg/day). As a rule, paroxysmal hemicrania responds to preventive treatment with indomethacin (75‐150 mg/day). A short course of intravenous lidocaine (1‐4 mg/kg/hour) can reduce the flow of attacks during exacerbations of SUNCT . Lamotrigine (100‐300 mg/day) is the preventive drug of choice for SUNCT . Gabapentin (800‐2700 mg/day), topiramate (50‐300 mg/day), and carbamazepine (200‐1600 mg/day) may be of help.