05/14/07 #5 - Chronic cluster headaches, neurologist afraid to prescribe lithium?

Ask the Clinician Health Pro May 14, 2007
  • FullQuestion:
    I have been suffering from chronic cluster headaches for the past 20 years since I was 25.  After numerous CT's and MRI tests from more than 2 dozen internists and neurologists they seem to give up on me.  I was prescribed verapamil (480 ml.) prednisone, Depakote, Topamax, Cafergot at different times.They all worked fine for a month or two, then it seems my body is becomes immune and rejects the drug. The headaches continue with a daily vengeance. Recently, I was taking Neurontin - 600 mg day which worked fine for a couple of months. As of today it seems my body is getting accustomed to it and the headaches continue. When I can no longer bear the unbearable pain, I take Maxalt which relieves it, but my prescription plan limits the amount I get every 3 months. I have no choice but to take it sparingly. I have taken Excedrin in huge amounts which is causing cyst in my liver. I am going crazy and cannot live with the daily pain. I ask my neurologist repeatedly toprescribe Lithium, but he is afraid of its killer side effects. Any help you can give will be most appreciated. Thanks, Dev.

    Answer:

    Dear Dev;

    Sometimes, a retrial of past medication that helped your cluster headaches may be wise. These may have to be rotated or used in combination. Newer medicationsthat we have found to be sometimes useful are Keppra or zonisamide. Although I don't like lithium either, sometimes a small amount (i.e., 300 mg) might make an appreciable difference in the pattern. Consultation with a headache expert would also be a wise thing to do.

    Good luck,
    John Claude Krusz and Teri Robert


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