Recent advances in the diagnosis and management of cluster headache

Abstract

Cluster headache, a primary headache disorder, consists of short (15-180 minutes), frequent (up to eight a day), unilateral attacks of facial pain with associated ipsilateral autonomic features and restlessness. The attacks are suspected to be one of the most painful human experiences, and the disorder is associated with a high rate of suicidal ideation. Proper diagnosis is key, as some of the most effective treatments, such as high flow oxygen gas, are rarely used in other headache disorders. Yet diagnostic delay is typically years for this disorder, as it is often confused with migraine and trigeminal neuralgia, and secondary causes may be overlooked. This review covers the clinical, pathophysiologic, and therapeutic features of cluster headache. Recent updates in diagnosis include the redefinition of chronic cluster headache (remission periods lasting less than three months instead of the previous one month), and recent advances in management include new treatments for episodic cluster headache (galcanezumab and non-invasive vagus nerve stimulation).

Circadian Features of Cluster Headache and Migraine

“…Corticosteroids (a daytime signal) and melatonin (a nighttime signal) are primary circadian-related hormones 10 and are also effective treatments in cluster headache and migraine. 3,4,18 As above, variations in the core clock gene CK1δ are associated with both advanced sleep-wake phase disorder and migraine. 13 Finally, core clock genes have downstream effects on gene expression.…”

“…Two primary headache disorders-cluster headache and migraine-share pathophysiology (hypothalamic and trigeminovascular activation) 1,2 and treatments (corticosteroids, galcanezumab, melatonin, noninvasive vagus nerve stimulation, sumatriptan, topiramate, and zolmitriptan). 3,4 They are also intermittent pain disorders, and the timing of attacks appears to follow a 24-hour pattern: both cluster headache and migraine attacks have been proposed to occur in the late evening or early morning. 5,6 Many of these features-hypothalamic activation, treatment with corticosteroids and melatonin, and a 24-hour pattern of attacks-suggest a role for the circadian clock.…”

Management of Trigeminal Autonomic Cephalalgias Including Chronic Cluster

“…Aiming on rare TACS, we decided to report data on chronic cluster headache for 2 reasons. First, episodic cluster headache was covered in several recent reviews between 2018 and 2022 . Second, data from the literature show that episodic and chronic cluster headache respond differently to treatments …”

“…First, episodic cluster headache was covered in several recent reviews between 2018 and 2022. [1][2][3][4] Second, data from the literature show that episodic and chronic cluster headache respond differently to treatments. [5][6][7] Methods A MEDLINE search in PubMed was performed from 2000 to 2022 for the terms cluster headache, paroxysmal hemicrania, hemicrania continua, SUNCT, and SUNA.…”

Self-treatment of depression and complex post-traumatic stress disorder with psilocybin and LSD—A retrospective case study

“…In the 1960s, psilocybin was utilized in individual psychotherapy and various types of group therapy (Passie, 2005). In recent years, psilocybin therapy has been studied for the treatment of depression, alcohol and nicotine dependency, and anxiety, as well as prophylaxis of episodic cluster headache (Meade et al, 2022;Mertens et al, 2022;Schindler and Burish, 2022). Various types of psychedelic therapy practice have been discussed in a recent book (Read and Papaspyrou, 2021).…”