Anticonvulsants: Levetiracetam IV: new cluster headache treatment

Abstract

Levetiracetam is used for control of seizures and has been useful for refractory headaches and pain, both orally and intravenously (1-3).We describe treatment of an acute flareup of cluster headache with intravenous levetiracetam. Five case reports are described at this point. All were males with onset of cluster headaches. 1 patient had co-existent migraines. At the headache clinic, an IV was placed and levetiracetam was given IV. 400-800mg test dose was given. 800mg was given every 10 minutes with monitoring. Patients rated their cluster severity on a 0-10 NRS scale. Average severity was 8/10. All 5 cases reported cessation of their cluster headache attacks with treatment. All were placed on oral levetiracetam for cluster prophylaxis. The average dose was about 7520mg over about 45-60 minutes. No side effects of any kind were reported other than transient drowsiness in 2 patients. IV levetiracetam is a possible option for treating acute cluster headaches. It is not available and has to be extracted. Safety, tolerability and, most importantly, efficacy have been demonstrated in this and other open-label studies (3) treating migraine and cluster headaches. Double-blind studies are warranted for levetiracetam IV