In Reply

We thank the correspondents for their letter, which enables us to draw attention to a misunderstanding. In our view, otorhinolaryngeal evaluation is not required in patients with cluster headache and typical symptoms. In contrast to the many descriptions of secondary cluster headache among pathological findings in the pituitary region, hardly any literature exists for sinusitis as the trigger of symptoms resembling cluster headache. By contrast it has been reported—and this is consistent with our own clinical experience —that 23% of patients with cluster headache were initially incorrectly diagnosed with sinusitis (1). In fact, treatment with intranasal application of lidocain has a secondary role compared to treatment with nasally or subcutaneously administered triptans, which are more effective. Moreover, we require cerebral MRI imaging in cluster headache, and extensive pathological findings in the Sinus sphenoidalis would thus be detected.

The mode of action of oxygen in acute cluster attacks has not been ultimately clarified. It has been shown, however, that oxygen inhalation is rapidly effective in stopping cluster attacks (3). Patients are usually free of pain within 15 minutes in 78% of attacks (compared to less than 20% inhaling “placebo” ambient air). Data on the effectiveness of hyperbaric oxygen treatment were collated in a Cochrane review (4) and showed no advantage of hyperbaric oxygen over oxygen inhalation. In our opinion it can be concluded that hyperbaric oxygen is not required in the treatment of cluster headache and that the mechanisms mentioned by Lamm and Müller-Kortkamp do not have an important role.

DOI: 10.3238/arztebl.2012.0150b

Dr med. Charly Gaul

Essen University Hospital, Clinic for Neurology, University of Essen and Duisburg, Germany

Director of the The West German Headache Center, Charly.Gaul@gmx.de

Dr med. Oliver M. Müller

Essen University Hospital, Clinic for Neurology, University of Essen and Duisburg, Germany

Conflict of interest statement
Dr Gaul has received honoraria for participating in an advisory board from Desitin and Allergan. He has received honoraria in the context of a publication from Boehringer Ingelheim. He has received travel and hotel expenses and honoraria for speaking from Berlin Chemie, MSD, and Allergan. He has been reimbursed for conducting commissioned clinical studies from MSD, Novartis, Complen Health, CoLucid Pharmaceuticals, and Bial. Dr Müller has received financial funding from St. Jude Medical and Medtronic for a patients’ information forum for cluster headache. He has also received travel and hotel expenses from both companies.