It is particularly important to note that, unlike other primary headaches, cluster headaches are not primarily influenced by psychological mechanisms. Changes in lifestyle, relaxation techniques, stress management, and other measures cannot significantly alter the course of cluster headaches. Most cluster headache patients are already aware at their initial consultation that alcohol consumption during cluster periods is "punished" with cluster attacks and therefore avoid it on their own. In any case, patients should be questioned about potential triggers.
It is particularly important that patients are thoroughly informed about their illness. The pain is usually devastating for patients. Without adequate information about the illness, without certainty about what they are suffering from, without a detailed explanation of the cause and development of the disease, there is a very high risk that patients will become so-called "pain cripples" and will be unable to participate in social or professional life. It is therefore essential that the treating physician not only exudes diagnostic and therapeutic confidence, but also possesses and implements this confidence. Only with a clear understanding of the illness will the patient consistently adhere to the treatment and comply with the prescribed measures.
The patient should be informed and supported about the possibility of being recognized as severely disabled. According to the principles of disability assessment, these conditions, analogous to trigeminal neuralgia, are to be recognized with a degree of disability (GdB/BdS) of 50 to 80, depending on the severity.
Information on self-help groups, education and possible support through internet forums should be provided (▶ http://www.clusterkopf.de/ , ▶ www.headbook.me )
At the initial consultation, the patient should receive a detailed treatment plan outlining the individual measures and their duration. The patient should be encouraged to keep a headache diary to accurately document attacks and their symptoms, allowing for monitoring of the course of the condition. The patient should be informed about the duration of prophylactic treatment, when to start taking specific medications, and what side effects to expect. They should also be informed about the general course of cluster headaches and understand that remission phases can occur over extended periods and that cluster headache episodes can recur months or even years later. This will prevent them from helplessly resorting to ineffective therapies for cluster headaches, such as acupuncture. It is particularly important to prevent superstitious behavior that could arise from a coincidence between inadequate treatment and the end of a cluster headache episode. Likewise, it can also occur through a coincidence of the use of ineffective therapy and the spontaneous termination of the time-limited acute cluster attack.
Given the potential for attacks to be triggered by alcohol, vasodilators such as nitrates, or histamine, patients should be informed to avoid these substances. A thorough medication history is also necessary. In some patients, nicotine can also provoke cluster headache attacks. For this reason, patients who smoke should be encouraged to quit. Dietary factors do not have a significant influence on the course of cluster headaches, which is why dietary measures are not promising for cluster headaches. A nitrate-free diet (no curing salts!) is recommended.