Treatment of cluster headache

Kingston, William; Dodick, David W.

doi:10.4103/aian.aian_17_18

Cited by 15 publications

(8 citation statements)

References 52 publications

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“…Noninvasive vagal nerve stimulation is well tolerated and has minimal adverse effects, such as short-term discomfort at the site of device application. They stimulate their bodies to treat themselves, and don" t need pharmacologic intervention [26].…”

Section: Non-invasive Vagal Nerve Stimulationmentioning

confidence: 99%

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The Role of CGRP Monoclonal Antibodies in the Treatment of Acute Cluster Headache

Cortes

2022

OAJNN

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This article discusses the role of Calcitonin Gene-Related Peptide antagonists available on the market in treating cluster headaches. All the treatments discussed in this article focus on either abortive, preventive, or transitional care. These therapies include Monoclonal Antibodies (Galcanezumab, Fremanezumab, Erenumab), high-flow oxygen, triptans (sumatriptan, zolmitriptan), Octreotide, non-invasive vagus nerve stimulation (vagus and sphenopalatine nerves), and other medications like dihydroergotamine, lidocaine, and capsaicin. We reviewed many studies from The United States since 2015; analytical methods were utilized. Moreover, we found that some of the treatment options for CH can vary depending on efficacy and route of administration and according to categories of therapy (acute or preventive). Every treatment has a specific and unique mechanism of action, indications, contraindications, and side effects. Therefore, the recommendation of one particular treatment should be considered in the success of the treatment of Cluster Headaches. Monoclonal Antibodies against CGRP have a unique role and are considered a first alternative in treating acute CH.

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Section: Non-invasive Vagal Nerve Stimulationmentioning

confidence: 99%

“…SPG stimulation's most common side effects were sensory disturbances and pain due to surgical implantation. This treatment is still under investigation and has not yet been approved by the FDA [26,27].…”

Section: Non-invasive Vagal Nerve Stimulationmentioning

confidence: 99%

The Role of CGRP Monoclonal Antibodies in the Treatment of Acute Cluster Headache

Cortes

2022

OAJNN

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“…2 Pharmacological treatments of CH include symptomatic drugs for pain relief, such as triptans and/or high-flow oxygen, and preventive drugs such as verapamil, topiramate, and lithium, which are effective in reducing CH attack frequency. 3 The factors underlying why up to 20%-30% of patients with CH do not benefit from symptomatic and/or preventive drugs remain largely unknown, [4][5][6] but it is widely accepted that interindividual variability of drug responses is explained, at least in part, by genetic factors. 7 Nonetheless, CH has a clear genetic basis as confirmed by family studies, which showed that first-and second-degree relatives of patients with CH have a significantly higher risk of CH compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

Gene polymorphism association studies in cluster headache: A field synopsis and systematic meta‐analyses

Cargnin

Sances²,

Smıth

et al. 2021

Headache

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Background A plethora of studies have attempted to identify genetic determinants of disease susceptibility and treatment response of patients with cluster headache (CH), but results are often conflicting, and no comprehensive overview with a quantitative summary of the evidence in this field is available. Methods A systematic search of relevant publications was performed without any language restrictions on PubMed, Web of Knowledge, Cochrane Library, and OpenGrey, up to December 2020. A standardized data extraction form was used to collect relevant data from each included study. Meta‐analyses were conducted for gene polymorphisms investigated in at least two studies and the Bayesian false discovery probability (BFDP) test was applied to the pooled odds ratios (ORs) to assess the credibility of the observed associations. Results Among the 27 articles identified by the systematic review, 17 studies evaluating 12 single nucleotide polymorphisms (SNPs) were included in the quantitative data analysis. The pooled results showed no significant association with CH risk of 10 SNPs, including five SNPs of HCRTR2 (rs2653349, rs2653342, rs3122156, rs10498801, and rs3800539), two SNPs of ADH4 (rs1800759 and rs1126671), CLOCK rs1801260, and two SNPs (rs1006417 and ADCYAP1R1 rs12668955) previously identified by a genome‐wide association study (GWAS). Conversely, the pooled results revealed the association of the HCRTR2 rs9357855 A allele with a higher risk of CH (A vs. G, OR: 1.33, 95% CI: 1.04–1.72, p = 0.026), and of GNB3 rs5443 with a higher response rate of patients with CH to triptan drugs (CT+TT vs. CC, OR: 1.96, 95% CI: 1.04–3.72, p = 0.038). However, assuming a prior probability of 0.001, the respective BFDP values being higher than 0.8 (BFDPrs9357855 = 0.998; BFDPrs5443 = 0.998) revealed lack of noteworthy results. Conclusions Well‐designed GWASs and large replication studies are still needed to identify reliable genetic variants of disease susceptibility and treatment response of patients with CH.

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“…It is characterised by strictly unilateral orbital, supraorbital or temporal headaches that severely compromise the quality of life of those who suffer from it. While there are a number of treatments available to alleviate CH symptoms, at least partially [ 1 ], further development is still needed to achieve complete suppression of headache attacks and effective management of commonly associated psychological symptoms (e.g. anxiety, depression).…”

Section: Introductionmentioning

confidence: 99%

Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache

et al. 2021

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Background Cluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls. Methods 21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient. Results Following treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus. Conclusions We provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.

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Treatment of cluster headache

Cited by 15 publications

References 52 publications

The Role of CGRP Monoclonal Antibodies in the Treatment of Acute Cluster Headache

The Role of CGRP Monoclonal Antibodies in the Treatment of Acute Cluster Headache

Gene polymorphism association studies in cluster headache: A field synopsis and systematic meta‐analyses

Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache

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