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Oxygen high concentration is a vasoconstrictor and relief vascular headache.
Massage and antidepressant probably not the effective treatment at this setting.
Nitroglycerine is a vasodilator and may worsen the vascular headaches.

CLUSTER HEADACHE

Cluster headache consists of recurrent brief attacks of sudden, severe, unilateral periorbital and retroorbital pain. Cluster headache exhibits a clustering of painful attacks over a period of many weeks. The pain lasts for one to two hours on average and may recur several times in a day. Cluster headaches also known as histamine headaches, red migraines, and Horton's disease,

Cluster headaches afflict less than 0.5% of the population and predominantly affect men; approximately 80% of sufferers are male. Onset typically occurs in the late 20s, but there is no absolute age restriction

Precipitating factors of cluster headache:

Alcohol
Tobacco
Histamine
Stress
Decreased blood oxygen levels (hypoxemia), particularly during the night when an individual is sleeping. (Interestingly, the triggers do not cause cluster headaches during remission periods.)

Sings and symptoms:

Ipsilateral conjunctival injection
Lacrimation
Nasal congestion
Ptosis
Miosis
Ipsilateral facial sweating, & flushing

Two types of cluster headaches:

Episodic cluster headache:

This type is more common. It disappears for over 14 consecutive days after less than one year of repeated attacks. Patient may have 2 or 3 headaches a day for about 2 months. The pattern then will repeat.

Chronic cluster headache:

This term designates the cluster headache, which does not remit for a year or more.

These two varieties are not fixed, in that episodic cluster headache can become chronic or vice versa.

Diagnostic criteria:

1. At least 5 attacks
2. Severe unilateral pain in the orbit or surrounding areas, or both, lasting 15-180 minutes untreated
3. Headache is associated with at least one of the above signs and symptoms on the side of the pain.
4. Frequency of attacks: from 1 every other day to 8 per day

Treatment:

SYMPTOMATIC
You can hold off cluster headache by breathing 100% oxygen from a tight-fitting mask at a flow rate of 7 liters per minute for 10-15 minutes. This straightforward treatment works for the majority of people.

Other abortive therapies include
ergotamine tartrate 1-2 mg orally or suppository, or nasal spray, dihydroergotamine (DHE 45) 0.5 to 1.5 mg IV, IM or SC
Subcutaneous sumatriptan (6 mg in 0.5 ml). Some patients have had satisfactorily rapid results with sumatriptan nasal spray.

PROPHYLACTIC

Prednisone 60mg/day taper over 2-3 weeks
Most series of episodic cluster headaches are reduced within a few days by oral prednisone. It is not generally prescribed for chronic cluster headaches, because it is too toxic for prolonged use.

Verapamil 240 - 480 mg, may take 2-3 weeks to work
Verapamil is effective against both episodic and chronic cluster headaches. A common and effective practice is to prescribe verapamil together with prednisone at the beginning of a new cluster period. After 2-3 weeks of this therapy, the verapamil generally exerts a sufficient preventive effect to permit most patients to rapidly wean off prednisone. This helps to prevent toxic effects of prednisone. Verapamil's major side effect is constipation.

Lithium 300 to 1200 mg per day in divided dose, for chronic Cluster headache.

Valproate 750 - 1500 mg/d, effective in episodic form.

Methysergide 2 to 8 mg per day in divided dose. Maximum 4 to 6 months, need 1 month drug holiday to avoid fibrotic complications.

Ergotamine 1-2mg/d
Ergotamine should probably be reserved for patients who fail to respond to verapamil, methysergide, methylergonovine, or lithium, and should be used for relatively short periods. It is not a good choice for the chronic form of cluster headache. It is often used as a nightly dose to prevent nocturnal attacks of cluster headache, either alone or together with standard doses of verapamil or lithium.

Surgical and radiation therapy

Surgical procedures and radiotherapy are rarely done, even for the chronic form.
Glycerol injection into the cistern of the trigeminal ganglion, Microvascular decompression of the trigeminal nerve.
Gamma-knife radiotherapy of the trigeminal ganglion.

Prevention

Avoid precipitating factors mentioned above.
Adhering to medical treatment.

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