[Therapeuetic aspects of cluster headache in the practical clinical site].

The therapeutic procedures of cluster headache begin from the precise diagnose. Because cluster headache is usually accompanied with teeth pain and/or neck pain, some patients aren't able to consult adequate medical institutions. In this lecture I showed the some male and female patients as examples. The female patient was suffered from menstruation related migraine in her period of cluster headache. From the view point of treatment, preventive medicines are essential. They not just reduce severity and also improve the length of headache-period. Suitable preventive medicines may avoid the whole severe attacks. We reported therapeutic experiences of valproate, gabapentin and amitriptyline with verapamil in 2010 at general meeting of Societas Neurologica Japonica. Steroids are not indispensable. As for triptans rapid-type one are usually used. If the attacks are severe, sumatriptan subcutaneous injection kit (SSI) needs to be introduced. The expert nurses who are skilled in the procedures of SSI improve both patients' adherence and therapeutic efficiency. We held a first educational meeting of SSI in Tokyo 2012. Because cluster headache is formidable, the integrated therapy which is composed of precise diagnosis, preventive medicine and adequate medicines for headache attacks is essential and needed.