Acute treatment and prevention of Horton headache
Treatment for Horton’s syndrome is divided into acute treatment and anti-seizure treatment. The purpose of acute treatment is to stop the onset of headache as soon as possible, while preventive treatment aims to reduce the number of seizures or, at best, prevent them altogether. The most effective treatment can be achieved by combining various acute and preventive methods.
The pain in the episode of the headache is extremely painful, which is why acute therapy must be able to quickly relieve the seizure. The two most effective and investigated acute treatment options are medical oxygen and triptans. The combination of treatment options can increase treatment efficacy.Medicinal oxygen
Medicinal oxygen increases the amount of oxygen in the blood and causes the blood vessels to contract, resulting in a total or partial loss of headache within 10-15 minutes. During a headache attack, the patient breathes 7 to 15 liters of oxygen through the face mask for 15 to 20 minutes. Treatment is effective in about 70% of patients by immediate discontinuation of the seizure or the sharpest point in the pain and making it more tolerable. Medicinal oxygen is a substitute for prescription medicine. The side effects are minor and oxygen therapy can be repeated as many times a day as is needed. Oxygen is delivered to the patient’s home and is taken care of by the physician.
Triptans are precise drugs used to treat migraine and serial headaches. They reduce blood vessels and reduce the release of analgesic agents. At the onset of the headache, the patient injects under the skin a pre-filled syringe of 6 mg sumatriptan called triptane. The maximum dose is two doses per day, and at least one hour between injections. Most of the injections are taken in the stomach, thigh or buttocks, where subcutaneous fat is usually the most common. The drug is rapidly absorbed into the bloodstream and ends up in the part of the body in which it is supposed to affect (the brain). Treatment is effective in 70-80% of patients who relieve pain or disappear within 5 to 10 minutes. Triptans are an effective form of acute treatment but do not prevent future seizures. In addition to subcutaneous injections, sumatriptan and zolmitriptan as triptans are available as nasal spray.
The treatment has no serious documented side effects, but it can cause a neck and chest tightness that is harmless but may seem unpleasant. Triptans should not be used in patients with a history of cerebrovascular accident, coronary artery disease or untreated hypertension.
Other acute treatments
There are a number of other acute treatment methods that can help with treating headaches, but they will only work after 30 to 45 minutes. Sumatriptan and zolmitriptan belonging to triptans are available as nasal spray as well as lidocaine local anesthetic.
Preventive treatment aims to reduce or stop headache attacks in the long term. In general, it is an add-on to acute treatment in patients with more than two headaches per day or with long sets. Most often, a combination of two treatments works well, but Horton patients are individualized and the treatment needs to be adapted to each patient’s own needs. Therefore, it is important that the treatment is performed by a neurologist who knows both the disease and the patient.