Lithium Carbonate in Cluster Headache: Assessment of Its Short- and Long-Term Therapeutic Efficacy

Abstract

The short- and long-term effects of administration of lithium carbonate in cluster headache (CH) have been investigated. Of the 90 patients treated (78 males and 12 females), 68 had episodic CH and 22 had the chronic form of the disease. The doses used were almost always 900 mg/day. Eleven of the 22 patients with chronic CH showed a definite, constant improvement both short and long term. In 7 of the 22 patients, lithium treatment provided excellent results initially but was later followed by some transient worsening; in the remaining 4 only partial benefits were observed initially and treatment proved still less effective after a few months. The effects of cessation of lithium administration after at least five months of continuous treatment were studied in 9 cases. In 6 of them the attacks re-appeared immediately, whereas in 3 the attacks occurred again only after free intervals of four to six months. Of the 68 patients with episodic CH, 26 proved highly responsive to treatment, 26 only partially responsive, and 16 refractory. In 3 cases, after one to three years of continuous treatment, euthyroid goitre developed, which disappeared after the drug was discontinued.

Outpatient Intravenous Dihydroergotamine for Refractory Cluster Headache

“…A cutoff of 2 weeks was chosen because the length of time it takes for verapamil to be effective is about 1 to 2 weeks in most cases. 1,2,8 Lithium takes 2 weeks, 1,[9][10][11][12][13][14] and valproate takes up to 1 week to be effective. 15 Success and Failure Rates in Relation to Duration of Exposure to Preventive Medication.-In the episodic and chronic forms of cluster headache combined, there was a 70% success rate of intravenous DHE treatment in patients who had previously been on preventive medication for more than 2 weeks.…”

Trigeminal–autonomic headaches in daily clinical practice

“…Most patients will benefit from dosages between 600 and 900 mg/day. The plasma level should be monitored and kept below 1.2 mmol/l [71]. As lithium in general has a narrow therapeutic window, it is recommended particularly for chronic CH when other drugs are ineffective or contraindicated.…”

Cluster Headache Pharmacotherapy

“…46 There have been many clinical trials looking at the effect of lithium on cluster headache and 2 double-blind, randomized trials. Collectively, 63% of episodic cluster patients respond to lithium therapy as opposed to 78% of those with chronic cluster.…”