Penatalaksanaan dd dan ds

TTH (Tension Type Headache)

03/10/2010 by omadfku02

Tension headaches atau lebih dikenal sebagai tension-type headaches(selanjutnya

akan disebut sebagai TTH) pemberian nama oleh International Headache Society pada
tahun 1988, adalah nyeri kepala yang paling sering dalam pembagian dari nyeri kepala.
Rasa nyeri menjalar dari mata ke dahi lalu ke arah atas telinga hingga ke bagian dari
belakang leher hingga ke pundak.TTH adalah nyeri yang meliputi hingga 90% dari semua
tipe nyeri kepala Cuma 3% dari seluruh populasi didunia yang menderita TTH Kronis
Frekuensi dan Durasi
TTH bisa terjadi secara akut dan kronis. Periode TTH akut adalah apabila TTH akut bila
keluhan muncul kurang dari 15 hari dalam 1 bulan, sedangkan TTH kronis adalah TTH
yang mucul lebih dari 15 hari selama 1 bulan dan keluhan ini muncul selama 6 bulan.
Durasi TTH dapat berlangsung selama beberapa menit , hari , bulan hingga bertahuntahun.
Pain and possible symptoms
Nyeri TTH seringkali dideskripsikan sebagai rasa tekan (terikat) yang konstan, kepala
bagaikan di ikat oleh tali.Rasa nyeri yang muncul seringkali bilateral (dua sisi ), dimana
yang artinya terjadi rasa tertekan pada kedua badian kepala pada saat yang bersamaan.
Nyeri khas TTH dari ringan hingga sedang, tapi bisa hingga berat.
Penyebab dan Pathofisiologi
Berbagai macam faktor pencetus yang dapat mengakibatkan munculnya TTH pada
seorang individu. Predisposisi penyebab munculnya TTH adalah karena stres dan
lapar (wikipedia)

Stres Muncul pada saat sore hari setelah mengalami stres panjang selama
bekerja atau setelah ujian

Kurangnya tidur /Sleep deprivation

Posisi yang tidak nyaman yang menyebabkan stres / posisi yang tidak benar

Waktu makan yang tidak pasti (lapar)

Kelelahan Mata

Withdrawal Kafein (Penghentian oleh efek kafein)

TTH mungkin juga disebabkan oleh ketegangan otot pada daerah sekitar kepala dan
leher. Salah satu teori mengatakan penyebab primer munculnya TTH dan migrain adalah
teeth clenching (menekankan gigi bawah dengan atas saat marah) yang menyebabkan
kontraksi yang kronis pada musculus temporalis. Salah satu ahli staff pada Mayo Clinic
menyatakan keraguannya teori peran oleh karena ketegangan pada otot temporalis,

namun tidak pernah ada penelitian yang pernah dilakukan oleh staf ahli dari yang
bersangkutan.
Teori lain mengatakan bahwa nyeri yang muncul disebabkan malfungsi dari penyaringan
rasa nyeri yang dimana asalnya berasal dari batang otak.Dimana otak mengalami
kesalahan dalam menginterprestasikan informasi yang diterima,sebagai contoh dari
signal yang harusnya untuk menggerakkan otot temporal atau otot lain, dimana ini
malah diinterprestasikan untuk memunculkan signal rasa nyeri . Salah satu dari
neurotransmitter primer yang kemungkinan berperan penting adalah serotonin. Salah
satu bukti dari teori ini datang dari fakta bahwa TTH yang kronis mungkin sembuh
dengan pemberian antidepresi tertentu sepertiamitriptyline. Namun, efek analgesik
amitriptyline ketegangan kronis-jenis sakit kepala bukan semata-mata karena inhibisi
reuptake serotonin, dan kemungkinan mekanisme lain yang terlibat. Kajian terbaru
oksida nitrat (NO) mekanisme menunjukkan bahwa NO dapat memainkan peran penting
dalam patofisiologi CTTH.Sensitisasi pada jalur nyeri dapat disebabkan oleh atau
berhubungan dengan aktivasi oksida nitrat sintase (NOS) dan generasi NO.Pasien
dengan ketegangan kronis-jenis sakit kepala telah meningkatkan rasa sakit otot dan
kulit kepekaan, ditunjukkan oleh rendahnya mekanis, panas dan tahanan listrik rasanyeri
.Nociceptive pusat dari neuron mengalami hiperexsitabilitas (dalam nukleus spinal
trigeminal, talamus, dan korteks serebral) yang diyakini terlibat dalam ketegangan
kronis patofisiologi-jenis sakit kepala. Bukti terbaru saat ini peningkatan sensitivitas
nyeri secara umum atau hyperalgesia pada TTH kronis membuktikan secara kuat bahwa
rasa sakit yang diproses di dalam CNS pada jalur rasa nyeri yang primer adalah kondisi
yang abnormal. Selain itu, disfungsi sistem inhibisi rasa sakit mungkin juga memainkan
peran penting dalam patofisiologi TTH kronis

Pengobatan/ Therapy
Episodik TTH kepala umumnya mempunyai respon yang baik dengan pemberian
analgesik seperti ibuprofen, parasetamol / asetaminofen, dan aspirin.Kombinasi
Analgesik/sedative digunakan secara luas(contoh , kombinasi analgesik/antihistamine
seperti Syndol, Mersyndol and Percogesic). Pengobatan lain pada TTH
termasuk amitriptyline / mirtazapine / dan sodium valproate (sebagai profilaksi).

Prognose
Ketegangan sakit kepala yang tidak terjadi sebagai gejala dari kondisi lain mungkin
menyakitkan, tetapi tidak berbahaya. Biasanya dimungkinkan untuk menerima bantuan
melalui perawatan. Ketegangan sakit kepala yang terjadi sebagai gejala dari kondisi lain
biasanya lega ketika kondisi-kondisi tersebut diobati. Sering menggunakan obat nyeri

pada pasien dengan ketegangan-jenis sakit kepala dapat mengakibatkan pengunakan

berlebihan obat sakit kepala atau Ketegangan sakit kepala yang tidak terjadi sebagai
gejala dari kondisi lain mungkin menyakitkan, tetapi tidak berbahaya. Biasanya
dimungkinkan untuk menerima bantuan melalui perawatan. Ketegangan sakit kepala
yang terjadi sebagai gejala dari kondisi lain biasanya lega ketika kondisi-kondisi tersebut
diobati. Sering menggunakan obat nyeri pada pasien dengan ketegangan-jenis sakit
kepala dapat mengakibatkan pengembangan berlebihan obat sakit kepala atau rebound
headache.

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Migraine Headaches
Migraine headaches affect more females than males in the United States.
Beforepuberty, boys and girls get migraines at about the same rate, although boys
may get them slightly more often. In individuals older than 12 years, the frequency of
migraines increases in both males and females. The frequency declines in
individuals older than 40 years.
In the United States, white women have the highest frequency of migraine, while
Asian women have the lowest. The female-to-male ratio increases from 2.5:1 at
puberty to 3.5:1 at age 40 years, after which it declines. The rate of migraine
headaches in females of reproductive age has increased over the last 20 years.
Migraine Headaches, Causes

The causes of migraine headaches are not clearly understood. In the 1940s, it was
proposed that a migraine begins with a spasm, or partial closing, of the arteries
leading to the main part of the brain (called thecerebrum). The first spasm decreases
blood supply to part of the brain, which causes the aura (lights, haze, zig-zag lines,
or other symptoms) that some people experience. These same arteries then become
too relaxed, which increases blood flow and causes pain.
About 30 years later, the chemicals dopamine and serotonin were found to play a
role in migraine headaches. (These chemicals are called
neurotransmitters.) Dopamine and serotonin are normally found in the brain, but they
can cause blood vessels to act in uncharacteristic ways if they are present in
abnormal amounts or if the blood vessels are unusually sensitive to them.
Together, these 2 theories have come to be known as the neurovascular theory of
migraine, and it is presently believed that both theories provide insight into the
causes of headache.
Various triggers are thought to initiate migraine headaches in people who are prone
to developing them. Different people may have different triggers.

Smoking has been identified as a trigger for many people.

Certain foods, especially chocolate, cheese, nuts, alcohol, and monosodium
glutamate (MSG), may trigger migraine headaches. (MSG is a flavor enhancer used in
many foods, including Chinese dishes.)
Missing a meal or changing sleep patterns may bring on a headache.
Stress and tension are also risk factors. People often have migraines during times of
increased emotional or physical stress.

Contraceptives (birth control pills) are a common trigger. Women may have
migraines at the end of the pill cycle as the estrogen component of the pill is stopped.
This is called an estrogen-withdrawal headache.
Migraine Headaches, Association with other diseases

Migraines may occur more frequently in persons with the following diseases:

Epilepsy

Familial dyslipoproteinemias (abnormal cholesterol levels)

Hereditary hemorrhagic telangiectasia

Tourette syndrome

Hereditary essential tremor

Hereditary cerebral amyloid angiopathy

Ischemic stroke: Migraine with aura is a risk factor (odds ratio, 6:1).

Depression and anxiety

Migraine Headaches, Clinical features

Headache is seldom the only feature of migraine, and it is sometimes entirely

absent. Some patients report a prodromal phase (an early phase before the start of a
full-blown condition, usually accompanied by certain symptoms) 24 hours before the
headache. Symptoms during this early phase may include irritability, depression, or
hyperexcitability. Migraine with aura (classic migraine) usually has several early
visual symptoms, including photopsia (flashes of light) and fortification spectra (wavy
linear patterns in the visual fields), or migrating scotoma (patches of blurred or
absent vision). The headache is usually described as throbbing or pulsing. Migraines
are typically unilateral (affecting one side), but the side affected in each episode may
change. Unilaterality is not a requirement for migraine diagnosis, however.
Nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to
sound), irritability, and malaise (general discomfort or uneasiness, an out-of-sorts
feeling) are common. The headache usually lasts for 6-24 hours. Migraineurs
generally prefer to lie quietly in a dark room.
Sometimes, a history of certain triggers can be identified. Common associations in
migraine include head injury, physical exertion, fatigue, drugs (nitroglycerine
[Nitrostat],

histamine, reserpine [Serpasil], hydralazine[Apresoline], ranitidine [Zantac],

estrogen), and stress.
If the headache is always on one side, the doctor must look for a structurallesion by
using imaging studies like magnetic resonance imaging (MRI). Having a history of
migraine attacks and determining what brings them on are important, because a
secondary headache can mimic a migraine headache and thus mask a new medical
problem.
Migraine Headaches, Variants

Migraine without aura (common migraine) is a throbbing headache without the

early visual symptoms.

Ophthalmic migraine is a type of migraine associated with eye problems. This

variant is sometimes called retinal migraine or ocular migraine.

Abdominal migraine is the term used to describe periodic abdominal pain in

children that is not accompanied by headache.

Complicated migraine is a type of migraine in which migraine attacks are

accompanied by permanent problems like paralysis.

Vertebrobasilar migraine manifests without headaches but with symptoms

like vertigo, dizziness, confusion, speech disturbances, tingling of extremities,
and clumsiness.

Status migrainosus is the term used to describe migraine attacks that persist for
days. These attacks may result in complications such asdehydration.
Migraine Headaches, Treatment overview

Avoid factors that cause a migraine attack (for example, lack of sleep,fatigue, stress,
certain foods, vasodilators).
Treat accompanying conditions (for example, anxiety, depression).
Oral birth control agents (contraceptives) may increase the frequency of headaches
in females. Women may be advised to discontinue oral contraceptives (or to use a
different form) for a trial period to see if they are a factor.
Migraine Headaches, Abortive treatment

Abortive treatments stop migraines quickly. Many drugs are now available for
immediate treatment of migraine attacks. The goal is rapid and effective relief of
headache. The most effective drugs for stopping a migraine are the triptans, which

specifically target serotonin receptors. They are all very similar in chemical structure
and action. The following is a list of triptans:

Sumatriptan (Imitrex, Imigran)

Zolmitriptan (Zomig, Zomig-ZMT)

Naratriptan (Amerge, Naramig)

Rizatriptan (Maxalt, Maxalt-MLT)

Almotriptan (Axert)

Frovatriptan (Frova)

Eletriptan (Relpax)

The following nontriptans also act on the serotonin receptors. They also act on some
other receptors, most likely on those for dopamine and noradrenalin. Sometimes,
they are effective when the triptans fail.

Ergotamine tartrate (Cafergot)

Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)

Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following are primarily used when nausea is a complicating factor in migraine
headache. In some cases, they also help relieve the headache.

Prochlorperazine (Compazine)

Promethazine (Phenergan)

Combination drugs like butalbital-acetaminophen-caffeine (Fioricet), butalbitalaspirin-caffeine (Fiorinal), or acetaminophen with codeine(Tylenol With Codeine) are
general painkillers in the narcotic class. They can help relieve any kind of pain to
some degree, whereas the triptans, ergotamines, and Midrin are used specifically for
headaches and do not help relieve arthritis, back pain, or menstrual cramps.
Treatment strategies are more successful if they are tailored to the individual patient
and are initiated early in the headache.
Patients with severe nausea and vomiting at the onset of an attack may at first
respond best to intravenous prochlorperazine. These patients may be dehydrated;
adequate fluid intake is necessary.

Vasoconstrictors (agents that narrow the blood vessels), such as ergotamines or

triptans, should not be given to patients with known complicated migraine without the
advice of a headache specialist. Instead, acute attacks should be treated with one of
the other available agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or
prochlorperazine.
Mild and infrequent attacks may not always require the use of ergotamines or
triptans and may be adequately treated with acetaminophen (Tylenol), NSAIDs, or a
combination of these.
About 40% of all attacks do not respond to triptans or any other substance. If all else
fails, migraineurs with an attack lasting more than 72 hours (status migrainous) can
be treated with intravenous medications. Brief hospitalization may be needed.
Migraine Headaches, Preventive treatment

Patients who have frequent acute migraine attacks and report that the attacks affect
their quality of life should consider preventive therapy as a supplement to the specific
headache-stopping drugs (abortive treatments) they use. The fequent use of
migraine abortive and analgesic medication has been associated with medication
overuse (rebound) headaches that may increease the frequency or severity of
headaches.
The goals of preventive therapy include decreasing the frequency and severity of
acute attacks and improving quality of life.
Patients with complicated migraine headaches who have a history of neurological
symptoms associated with their attacks are definite candidates for preventive
therapy. For these patients, even a single previous complicated migraine episode
qualifies them for long-term preventive therapy.
The choice of preventive medication should be tailored to the individual's profile,
taking into account comorbidities (concurrent medical conditions) such as
depression, weight gain issues, exercise tolerance, asthma, andpregnancy plans. All
medications have side effects; therefore, selection must be individualized.
Preventive drugs include beta-blockers, tricyclic antidepressants, some
anticonvulsants, calcium channel blockers, cyproheptadine (Periactin), and NSAIDs
such as naproxen (Naprosyn). Unlike the specific headache-stopping drugs (abortive
drugs), most of these were developed for other conditions and have been
coincidentally found to have headache preventive effects. The following drugs also
have preventive effects; unfortunately, they also have more side effects:

Methysergide maleate (Sansert): This drug has many side effects.

Lithium (Eskalith, Lithobid): This drug has many side effects.

Indomethacin (Indocin): This drug can cause psychosis in some people with cluster
headaches.

Steroids: Prednisone (Deltasone, Meticorten) works extremely well for some people
and should be tried if other therapies fail.

How long a person should follow a preventive therapy plan is a function of his or her
response to the drug being taken. If headaches completely stop, it is reasonable to
gradually reduce the dosage so long as headaches do not recur
Cluster Headache Overview
Patient CommentsRead 3 CommentsShare Your Story
Cluster headache is far less common thanmigraine headache or tension headache.
Clusterheadaches begin far more dramatically, however, and remain quite unique in
their course over time.
As the name suggests, the cluster headache exhibits a clustering of painful attacks
over a period of many weeks. The pain of a cluster headachepeaks in about 5
minutes and may last for an hour. Someone with a clusterheadache may get
several headaches a day for weeks at a time - perhaps months - usually interrupted
by a pain-free period of variable length.
In contrast to people with migraine headache, perhaps 5-8 times as many men as
women have cluster headache. Most people get their first cluster headache at age
25 years, although they may experience their first attacks in their teens to early 50s.
You can get 2 types of cluster headache:

Episodic: This type is more common. You may have 2 or 3headaches a day for
about 2 months and not experience another headache for a year. The pattern then will
repeat itself.

Chronic: The chronic type behaves similarly but, unfortunately, you get no period of
untreated sustained relief.

Cluster Headache Causes

No one knows exactly what causes cluster headaches. As with many other
headache syndromes, theories abound, many of which center on your autonomic or
"automatic" nervous system or your brain'shypothalamus. These systems play a role
in rhythmic or cyclical functions in your body. The involvement of either system in the
syndrome would account for the periodic nature of the headache.

Many experts believe that cluster headache and migraine headache share a
common cause that begins in the nerve that carries sensation from your head to your
brain (trigeminal nerve) and ends with the blood vessels that surround your brain.

Others believe that the pain arises in the deep vascular channels in your head (for
example, the cavernous sinus) and does not involve the trigeminal system

Cluster Headache Symptoms

The pain of cluster headache is its defining and most dramatic feature. This pain
comes on without warning (no forewarning symptoms such as the aura in classic
migraine) and may begin as a burning sensation on the side of your nose or deep in
your eye.
The pain peaks in just a few minutes. People describe the feeling as having an ice
pick driven through your eye. They use words such as "excruciating," "explosive,"
and "deep." This stabbing eye pain carries with it a rapid electrical-shocklike
element, which may last for a few seconds, and a deeper element that continues for
a half-hour or longer. The pain almost always begins in your eye and always on 1
side of your face. Interestingly, for most people the pain stays on the same side of
the face from cluster to cluster, while in a small minority the pain switches to the
opposite side during the next cluster.
In addition to its one-sidedness, other characteristics separate cluster headaches
from other headaches.

The headaches commonly come on just after you go to sleep.

Often the eye on your affected side will tear.

Your eyelid on the affected side will droop.

You will experience one-sided nasal stuffiness and runny nose.

Cluster headaches have seasonal variations. Most attacks occur in January and
July, where the days are in turn the shortest and longest.

Self-Care at Home
Patient CommentsShare Your Story

You can treat cluster headache at home under a doctor's care. Treatment involves 2
types of care, and many people require both at the same time:

Preventive treatment: This includes ongoing use of medications proven effective in

holding off headaches or limiting their number, even when you are not experiencing
headaches. Examples are drugs like beta-blockers

(propranolol [Inderal], atenolol[Tenormin]), anticonvulsants (topiramate [Topamax],

divalproex [Depakote], carbamazepine [Tegretol]),tricyclic
antidepressants (amitriptyline[Elavil], nortriptyline [Aventyl]), and calcium channel
blockers (verapamil[Covera]). Though widely used, the selective serotonin reuptake
inhibitor (SSRI) class
of antidepressant (fluoxetine [Prozac],paroxetine [Paxil], escitalopram [Lexapro]) is
relatively ineffective for headache.

Abortive treatment: This is designed to stop a headache once it has begun.

Medications include ergotamine (Bellamine, Cafergot),acetaminophen-isometheptenedichloralphenazone (Midrin),dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal
Spray), and more recently, the drugs of the triptan family
(almotriptan [Axert],eletriptan [Relpax], frovatriptan [Frova], naratriptan [Amerge],rizatripta
n [Maxalt], sumatriptan [Imitrex], zolmitriptan [Zomig]).

In addition, many medications used to treat migraine headache (Excedrin

Migraine Pain Reliever/Pain Reliever Aid, oxygen, prednisone[Deltasone]) can also be
used for cluster headache
http://www.emedicinehealth.com/script/main/art.asp?articlekey=59403&page=8

Cluster headache can be either ongoing or come and go, and people can jump from
one type to the other. Many people who have cluster headache are pain-free for a
year or longer, only to have the frustrating cycle of daily headaches begin again.
As is the case with migraine, people with cluster headaches respond to therapies
that are widely available and are becoming less expensive. With proper medical
treatment and guidance, you can control cluster headach
Cluster penatalaksanaan:

Treatments and drugs

By Mayo Clinic Staf

Appointments & care

At Mayo Clinic, we take the time to listen, to find answers and to

provide you the best care.

Learn more. Request an appointment.

There's no cure for cluster headaches. The goal of treatment is to decrease

the severity of pain, shorten the headache period and prevent the attacks.
Because the pain of a cluster headache comes on suddenly and may
subside within a short time, cluster headache can be difficult to evaluate
and treat, as it requires fast-acting medications.
Some types of acute medication can provide some pain relief quickly.
Based on the latest studies, the therapies listed below have proved to be
most efective for acute and preventive treatment of cluster headache.

Acute treatments
Fast-acting treatments available from your doctor include:

Oxygen. Briefly inhaling 100 percent oxygen through a mask at a

minimum rate of at least 12 liters a minute provides dramatic relief for
most who use it. The efects of this safe, inexpensive procedure can be
felt within 15 minutes.
The major drawback of oxygen is the need to carry an oxygen cylinder
and regulator with you, which can make the treatment inconvenient and

inaccessible at times. Small, portable units are available, but some

people still find them impractical.

Triptans. The injectable form of sumatriptan (Imitrex), which is

commonly used to treat migraine, is also an efective treatment for acute
cluster headache.
The first injection may be given while under medical observation. Some
people may benefit from using sumatriptan in nasal spray form, but for
most people this isn't as efective as an injection and it may take longer
to work. Sumatriptan isn't recommended if you have uncontrolled high
blood pressure or heart disease.
Another triptan medication, zolmitriptan (Zomig), can be taken in nasal
spray or tablet form for relief of cluster headache. This medication may
be an option if you can't tolerate other forms of fast-acting treatments.

Octreotide. Octreotide (Sandostatin), an injectable synthetic version

of the brain hormone somatostatin, is an efective treatment for cluster
headache.

Local anesthetics. The numbing efect of local anesthetics, such as

lidocaine (Xylocaine), may be efective against cluster headache pain in
some people when given through the nose (intranasal).

Dihydroergotamine. The intravenous form of dihydroergotamine

(D.H.E. 45) may be an efective pain reliever for some people with
cluster headache. This medication is also available in an inhaled
(intranasal) form called Migranal, but this form hasn't been proved to be
efective.
To have the medication administered through a vein (intravenously),
you'll need to go to a hospital or doctor's office to have the medication
administered through a vein (intravenously).

Preventive treatments
Preventive therapy starts at the onset of the cluster episode with the goal of
suppressing attacks.
Determining which medicine to use often depends on the length and
regularity of your episodes. Under the guidance of your doctor, the drugs
can be tapered of once the expected length of the cluster episode ends.

Calcium channel blockers. The calcium channel blocking agent

verapamil (Calan, Verelan, others) is often the first choice for preventing
cluster headache. Verapamil is often used in conjunction with other
medications. Occasionally, longer term use is needed to manage
chronic cluster headache.
Side efects may include constipation, nausea, fatigue, swelling of the
ankles and low blood pressure.

Corticosteroids. Inflammation-suppressing drugs called

corticosteroids, such as prednisone, are fast-acting preventive
medications that may be efective for many people with cluster
headaches.
Your doctor may prescribe corticosteroids if your cluster headache
condition has only recently started or if you have a pattern of brief
cluster periods and long remissions.
Although corticosteroids may often be a good short-term option, serious
side efects such as diabetes, hypertension and cataracts make them
inappropriate for long-term use.

Lithium carbonate. Lithium carbonate, which is used to treat bipolar

disorder, may be efective in preventing chronic cluster headache if
other medications haven't prevented cluster headaches.
Side efects include tremor, increased thirst and diarrhea. Your doctor
can adjust the dosage to minimize side efects.

While you're taking this medication, your blood will be checked regularly
for the development of more-serious side efects, such as kidney
damage.

Nerve block. Injecting a numbing agent (anesthetic) and

corticosteroid into the area around the occipital nerve, located at the
back of your head, may help improve chronic cluster headaches.
An occipital nerve block may be useful for temporary relief until longterm preventive medications take efect.

Ergots. Ergotamine, available as a tablet that you place under your

tongue, can be taken before bed to prevent nighttime attacks.
Self-injected dihydroergotamine (D.H.E. 45) also may be helpful. Ergot
medications may be efective if taken early in your cluster attacks, but
they can't be combined with triptans and can only be used for brief
periods of time.

Melatonin. Studies show that 10 milligrams of melatonin taken in the

evening might reduce the frequency of cluster headache.

Other preventive medications used for cluster headache include antiseizure medications such as divalproex (Depakote) and topiramate
(Topamax).

Surgery
Rarely, doctors may recommend surgery for people with chronic cluster
headache who don't find relief with aggressive treatment or who can't
tolerate the medications or their side efects.
Surgical procedures for cluster headache attempt to damage the nerve
pathways thought to be responsible for pain, most commonly the trigeminal
nerve that serves the area behind and around your eye.
However, the long-term benefits of surgery are disputed. Also, because of
the possible complications including muscle weakness in your jaw or

sensory loss in certain areas of your face and head it's rarely
considered.

Research in potential cluster headache treatments

As scientists learn more about the causes of cluster headache, they're able
to develop more-selective treatments for the condition.
Researchers are studying a potential treatment called occipital nerve
stimulation. In this procedure, your surgeon implants electrodes in the
back of your head and connects them to a small pacemaker-like device
(generator). The electrodes send impulses to stimulate the area of the
occipital nerve, which may block or relieve your pain signals.
Several small studies of occipital nerve stimulation found that the procedure
reduced pain in some people with chronic cluster headaches.
Similar research is underway with deep brain stimulation. In this
procedure, doctors implant an electrode in the hypothalamus, the area of
your brain associated with the timing of cluster periods. Your surgeon
connects the electrode to a generator that changes your brain's electrical
impulses and may help relieve your pain.
Deep brain stimulation of the hypothalamus may provide relief for people
with severe, chronic cluster headaches that haven't been successfully
treated with other medications.
Researchers are studying other types of brain and nerve stimulation to
prevent and treat cluster headaches

The following measures may help you avoid a cluster attack during a cluster
cycle:

Stick to a regular sleep schedule. Cluster periods may begin when

there are changes in your normal sleep schedule. During a cluster
period, follow your usual sleep routine.

Avoid alcohol. Alcohol consumption, including beer and wine, often

can quickly trigger a headache during a cluster period

Alternative medicine

By Mayo Clinic Staf

Because cluster headaches can be so painful, you may be tempted to

try alternative or complementary therapies to relieve your pain.
A survey of people with cluster headache who tried a number of
alternative therapies including acupuncture, acupressure,
therapeutic touch, chiropractic and homeopathy found that fewer
than 10 percent thought these therapies efective.
Some natural medicines may be worth a try, however. In one study,
extract from kudzu, a vine species originally found in Asian countries,
was shown to alleviate the intensity, frequency and duration of cluster
headache attacks. However, kudzu extract didn't decrease the length
of the cluster cycle.
Melatonin also has shown modest efectiveness in treating nighttime
attacks

Coping and support

By Mayo Clinic Staf

Living with cluster headache can be very difficult. Cluster headaches can
be frightening to you and to your family and friends. The debilitating attacks
may seem unbearable.
In addition to the physical symptoms, the chronic pain that often
accompanies cluster headache attacks can make you anxious or
depressed. Ultimately, it may afect your interaction with friends and family,
your productivity at work, and the overall quality of your life.
Talking to a counselor or therapist can help you cope with the efects of
cluster headache. Or you may find encouragement and understanding in a
headache support group. Although support groups aren't for everyone, they
can be good sources of information.

You may also find support groups are a good place for you to share your
experiences and hear other group members' experiences. If you're
interested, your doctor may be able to recommend a group in your area.

Prevention
By Mayo Clinic Staf

Because the cause of cluster headache is unknown, you can't prevent a

first occurrence. However, a preventive strategy is crucial for managing
cluster headache because only trying to treat acute attacks with
medications can seem hopeless.
Prevention can help reduce the frequency and severity of the cluster
attacks and the risk of medication overuse headaches. Preventive
medications can also increase the efectiveness of acute medications.
In addition, you may help reduce your risk of future attacks by avoiding
alcohol and nicotine, which often cause cluster headaches.

Sumber : http://www.mayoclinic.org/diseases-conditions/clusterheadache/basics/treatment/con-20031706