Topiramate in the Prophylactic Treatment of Cluster Headache

Láinez, Miguel J. A.; Pascual, Julio; Pascual, Ana; Santonja, Jose M.; Ponz, Alejandro; Salvador, Antonio Caridad

doi:10.1046/j.1526-4610.2003.03137.x

Cited by 93 publications

(53 citation statements)

References 25 publications

(34 reference statements)

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“…In an open-label study, topiramate rapidly induced cluster remission in 64.3% of CCH patients and in 50% of ECH patients [30]. All chronic patients and 75% of episodic patients had poor or no response to other preventive treatments.…”

Section: Therapymentioning

confidence: 96%

Chronic cluster headache: a review

2005

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Cluster headache (CH) is a rare but severe headache disorder characterised by repeated unilateral head pain attacks accompanied by ipsilateral autonomic features. In episodic CH, there are periods of headache attacks with pain–free intervals of weeks, months or years in between. A minority of patients have the chronic form, without pain–free intervals between the headache attacks. Chronic CH can occur as primary or secondary chronic CH; the rarest form is episodic CH arising from chronic CH. In this article, we give a review of the chronic forms of CH and focus on demographics, clinical manifestations, social habits, predictive factors, head injury, genetics, neuroimaging and therapy. It is remarkable that little is known about risk factors that make CH chronic.

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Section: Therapymentioning

confidence: 96%

Chronic cluster headache: a review

2005

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“…[46][47][48][49] However, there is some conflicting evidence, 50 and care must be taken to avoid sideeffects, which include dyspepsia, peripheral paraesthesiae, ataxia, dizziness, weight loss, exacerbation of renal stones, and cognitive impairment. However, if side-effects are minimal or tolerable, topiramate remains a feasible option in cluster headache.…”

Section: Longer-term Prophylaxismentioning

confidence: 99%

Prevention and treatment of cluster headache

Cohen¹,

Goadsby²

2009

Prog Neurol Psychiatry

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CCluster headache (CH) is a stereotypical primar y headache syndrome, characterised by attacks of unilateral excruciating pain usually in the eye, periorbital region and temple, with associated cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal blockage, rhinorrhea, ptosis, and eyelid oedema. Restlessness and agitation also feature prominently. Attacks last for 15-180 minutes, and have a frequency of one every other day up to eight a day. 1 They can be triggered by alcohol, 2 usually in under an hour, in contrast to migraine for which alcohol typically takes longer to trigger an attack. CH attacks often occur with so-called clock-like regularity, and may be precipitated by sleep.CH has a prevalence of 0.1 to 0.3 per cent in the general population, 3 and affects slightly more men than women, with a male: female ratio of 2.5:1 in a recent study. 2 Episodic cluster headache (ECH) is defined as bouts of attacks lasting from seven days up to one year, with breaks of one month or more between bouts. In chronic cluster headache (CCH) attacks occur for more than one year without remission, or with remissions lasting less than one month. In CCH there are micro-periods, and seasonal variation is sometimes seen. Unaware of this, clinicians and patients may feel prophylactics have 'stopped working' although in fact the disorder has changed. Over years this can lead to a creeping upwards of medicine doses and eventual accrual of side-effects. If one is aware of the phenomenon of periodicity even in CCH, the physician can, after a period of increased dosing, revert to the previous dose, or preferably use other strategies for short-term care to avoid changing the baseline preventive dose.CH is probably the most severe pain known to humans, with female patients describing each attack as worse than childbirth. Health-related quality of life is significantly impaired in CH suf ferers. 4,5 Even though it is under-recognised and often suboptimally managed in primary care, 6,7 an early diagnosis and prompt treatment are essential to alleviate the devastating morbidity of these attacks. 8 DiagnosisThe diagnosis is usually clear on taking a thorough history. The presence of autonomic symptoms, restlessness, and the length of the attacks usually distinguishes this from migraine, although a proportion of migraine patients may exhibit cranial autonomic features, 9-11 and migraine can coexist with CH by chance. The differential diagnosis for CH includes the other trigeminal autonomic cephalalgias (TACs), which are paroxysmal hemicrania (PH) and SUNCT (shor t-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), although these dif fer from CH in that the attack lengths are shorter. 1 There is considerable overlap in attack frequency, such that typical CH patients have one to two attacks a day, typical PH patients 10 and typical SUNCT/SUNA patients 50, there is a marked skew that favours lower attack frequencies. 12 Another useful clinical pointer is the lateralisation of photo...

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“…In der letzten Zeit wurde vermehrt über den Einsatz von Topiramat zur Prophylaxe des Clusterkopfschmerzes berichtet [6,14,17,25], wobei die Mehrzahl der Untersuchungen eine Wirksamkeit von Topiramat belegten [6,14,25]. Topiramat soll stabilisierende Effekte auf Zellmembranen haben und die Schmerzwahrnehmung direkt modulieren [29].…”

Section: Topiramatunclassified

Behandlung eines atypischen und therapierefraktären Clusterkopfschmerzes mit Topiramat

Kuhn

Bewermeyer

2006

Schmerz

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Cluster headache is the third most frequent type of primary cephalgia only exceeded in frequency by tension-type headache and migraine. Cluster headache is characterized by periodic attacks of unilateral excruciating pain and accompanying autonomic features. It is arguably the most disabling form of primary headache. Therefore, prompt recognition of this disorder is necessary to provide an opportunity for effective treatment. We report on a patient with cluster headache, who complained about an atypical interval of dull headache between the cluster attacks, thus excluding the differential diagnosis of hemicrania continua. The common drugs for acute cluster attacks proved to be ineffective as well as prophylactic treatment with steroids and verapamil. Only administration of topiramate led to relief of pain.

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Topiramate in the Prophylactic Treatment of Cluster Headache

Abstract: Our results confirm that topiramate can be an effective option for the preventive treatment of episodic and chronic cluster headache.

Cited by 93 publications

References 25 publications

Chronic cluster headache: a review

Chronic cluster headache: a review

Prevention and treatment of cluster headache

Behandlung eines atypischen und therapierefraktären Clusterkopfschmerzes mit Topiramat

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