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Cluster‐Like Headaches Associated With Internal Carotid Artery Dissection Responsive to Verapamil

Cluster headache is a disorder of episodic, brief, severe, unilateral pain centered in or around the eye.The pain builds within 15 minutes to excruciating levels, and is described as deep, constant, and boring, piercing, or burning in nature.At least one of the following associated autonomic symptoms must also occur: conjunctival injection, eyelid edema, facial sweating, lacrimation, miosis, nasal congestion, ptosis, or rhinorrhea. A minority of patients have associated nausea, vomiting, photophobia, or phonophobia. During an attack, patients often feel agitated or restless. The attack frequency varies from one every other day to 8 a day. The attacks often occur at the same time each day, frequently during sleep. Untreated, the attacks usually last from 30 to 90 minutes, but may last up to 180 minutes. In episodic cluster headache, cluster periods usually last from 1 to 3 months, with remission between cluster periods lasting 6 months to 2 years. Most patients have 1 or 2 cluster periods a year that last 2 to 3 months, with 1 to 2 attacks a day. Chronic cluster headache has either no remission periods or remissions that last less than 14 days. To stop an individual headache, oxygen, subcutaneous, or intranasal sumatriptan is commonly used. To stop a cluster cycle, a course of prednisone is often used. To stop a cluster cycle as well as to prevent the next cluster cycle from starting, verapamil is commonly used. One study found that verapamil 120 mg 3 times daily was effective in stopping cluster headache attacks, although most patients required 2 weeks before complete prevention was achieved.