Cluster headache lithium

The authors commented that the manic symptoms had probably been caused by glucocorticoids or glucocorticoid withdrawal. They concluded that patients with cluster headache and a history of affective disorder should not be treated with glucocorticoids, but with valproate or lithium, which are effective in both conditions. Lamotrigine, an anticonvulsive drug with mood-stabilizing effects, may prevent glucocorticoid-induced mania in patients for whom valproate or lithium are not possible (101). 

Chronic cluster headache has responded to lithium (13). Sensory systems... 

Lithium carbonate is effective against episodic and chronic cluster headache attacks, with beneficial effects often appearing during the first week of therapy. A positive response is seen in up to 78% of patients with chronic cluster headache and in up to 63% of patients with episodic cluster headache." The usual dose of lithium for cluster headache is 600 to 900 mg/day administered in divided doses. Tachyphylaxis to lithium has been reported occasionally during prolonged therapy." Optimal plasma lithium levels for the prevention of cluster headache have not been established, but efficacy has been reported at relatively low serum concentrations (0.3-0.8 mEq/L)." ... 

Initial side effects are mild and include tremor, lethargy, nausea, diarrhea, and abdominal discomfort. Lithium treatment has been associated with headache symptoms described as episodes of moderately severe, throbbing occipital pain lasting 6 to 12 hours, but these headaches are easily distinguishable from the cluster headache and disappear when lithium is withdrawn. Lithium should be administered with caution to patients with significant renal or cardiovascular disease, dehydration, pregnancy, or concomitant diuretic use. 

Ergotamine can be an efficacious agent for prophylactic as well as abortive therapy of cluster headaches." A 2-mg bedtime dose is often beneficial for the prevention of nocturnal headache attacks. Daily use of 1 to 2 mg ergotamine alone or in combination with verapamil or lithium may provide effective headache prophylaxis in patients refractory to other agents with little risk of ergotism or rebound headache." - ... 

Corticosteroids are useful for chronic cluster headaches refractory to verapamil, lithium, ergotamine, and methysergide or combinations of these agents." Therapy is initiated with 40 to 60 mg/day prednisone and tapered over approximately 3 weeks. Relief appears within 1 to 2 days of initiating therapy. To avoid steroid-induced complications, long-term use is not recommended. Headaches may recur when therapy is tapered or discontinued. 

During the past three decades, it has been possible to extend the classical antimanic, antidepressive and recurrent-prophylactic action profile of lithium by an antipsychotic (Alexander et al. 1979), antiaggressive (Nilsson 1994), antisuicidal (Mtiller-Oerlinghau-sen et al. 1992), antineurotic (PfafFenrath et al. 1982) and neuroprotective (Ermidou-Pollet and Pollet 2002) component. Though lithium is even the first-choice treatment in the prophylaxis of chronic and episodic courses of cluster headache in patients, who are aged over 45 years (Pfaf-fenrath et al. 1982), all the results with the antineurotic properties of lithium are based on open trials. Clear evidence of the antineurotic effect of lithium has not yet... 

Lithium may reduce the frequency of cluster headaches in 77% of patienfs (n=26) receiving it in an open naturalistic setting [45 Litirium does not reduce marble-burying behavior, the obsessive-compulsive equivalent of the human condition foxmd in mice [46 " " study]. 

Stochino ME, Deidda A, Asuni C, Cherchi A, Manchia M, Del Zompo M. Evaluation of lithium response in episodic cluster headache a retrospective case series. Headache 2012 52(7) 1171-5. 

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