Behavioral treatment of chronic cluster headache in a geriatric patient.

While nonpharmacological treatment of migraine and tension headache has increasingly been demonstrated to be efficacious, relatively little attention has been focused upon treatment of the more severe cluster headache. This has particularly been the case for the type of cluster headache known as chronic cluster. The present case study focused upon the treatment of a 69-year-old male with a 37-year history of headache activity. The description of headache matched those criteria currently considered to be indicative of chronic cluster headache. Following 6 weeks of baseline, during which daily ratings of head pain and daily ingestion of "as needed" (PRN) pain medication were collected, a 7-week treatment phase was implemented. Treatment consisted of thermal biofeedback coupled with a spouse contingency program (i.e., directing the spouse to avoid consequating subject reports of head pain). During the treatment phase, a near-100% reduction in amount of weekly PRN pain medication ingested was noted, along with a decrease in self-reports of head pain. Both of these decreases were maintained at 1-month, 4-month, and 15-month follow-ups. Implications for treatment of chronic cluster headache were discussed.