Warfarin for Refractory Chronic Cluster Headache: A Randomized Pilot Study

Hakim, Sameh M.

doi:10.1111/j.1526-4610.2011.01856.x

Cited by 27 publications

(30 citation statements)

References 59 publications

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“…MO and other unspecified non-migrainous headaches have been considered in one study [3], while an improvement in MO, migraine with aura, hemiplegic migraine and chronic cluster headache has been sporadically documented [2,[5][6][7]. However, warfarin seems to be principally effective in reducing the frequency of migraine rather of other primary headaches [2,3].…”

Section: Discussionmentioning

confidence: 92%

Warfarin prophylaxis in migraine without aura but not in primary exercise headache

2015

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Section: Discussionmentioning

confidence: 92%

Warfarin prophylaxis in migraine without aura but not in primary exercise headache

2015

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“…A Class II crossover study of 34 patients with chronic CH evaluated the use of warfarin with an International Normalized Ratio goal of 1.5 to 1.9 over a 12‐week treatment period. In the intention to treat analysis, 50% underwent remission for 4 weeks during the warfarin period compared with 11.8% patients during the placebo period ( P = .004), associated with a relative risk of 0.57, absolute risk reduction of 0.38 (95% CI 0.18‐0.58), and a number needed to treat of 2.6 (95% CI 1.7‐5.5).…”

Section: Resultsmentioning

confidence: 99%

“…Warfarin is the only medication that has been administered a new positive recommendation (Level C). The rationale for studying this treatment for CH was derived from anecdotal reports of incidental CH benefit in patients taking warfarin for other indications . The study author hypothesized that the potential benefit of warfarin in CH treatment relates to the impact of vitamin K antagonism on dendritic and neuronal metabolism, circadian rhythms of the hypothalamus, and nitric oxide mediated neurogenic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

et al. 2016

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Background.-Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. New evidence-based treatment guidelines for CH will assist clinicians with identifying and choosing among current treatment options.Objectives.-In this systematic review we appraise the available evidence for the acute and prophylactic treatment of CH, and provide an update of the 2010 American Academy of Neurology (AAN) endorsed systematic review.Methods.-Medline, PubMed, and EMBASE databases were searched for double-blind, randomized controlled trials that investigated treatments of CH in adults. Exclusion and inclusion criteria were identical to those utilized in the 2010 AAN systematic review.Results and Recommendations.-For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine ganglion stimulation was added to the current guideline and has been administered a Level B recommendation for acute treatment. For prophylactic therapy, previously there were no treatments that were administered a Level A recommendation. For the current guidelines, suboccipital steroid injections have emerged as the only treatment to receive a Level A recommendation with the addition of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation (positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U recommendation (frovatriptan).Conclusions.-This AHS guideline can be utilized for understanding which therapies have superiority to placebo or sham treatment in the management of CH. In clinical practice, these recommendations should be considered in concert with other variables including safety, side effects, patient preferences, clinician experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level A recommendations, particularly for a number of commonly used preventive therapies, further studies are warranted to demonstrate safety and efficacy for established and emerging therapies.

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“…Après la description de l'efficacité de la warfarine [124] dans une observation clinique, un essai en double insu contre placebo a confirmé l'efficacité de la warfarine dans la forme chronique réfractaire de l'AVF (grade B) [125]. La mélatonine a eu une efficacité modeste dans une étude pilote en double insu chez des patients avec une forme épisodique d'AVF [126], les résultats étant négatifs dans la forme chronique [126,127].…”

Section: Autres Moléculesunclassified

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

Donnet

Demarquay

Ducros

et al. 2015

Douleurs : Evaluation - Diagnostic - Traitement

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Warfarin for Refractory Chronic Cluster Headache: A Randomized Pilot Study

Abstract: In patients with refractory chronic cluster headache, low-intensity anticoagulation with warfarin was associated with significantly higher incidence of remission and less impact of headache on patients' lives compared with placebo.

Cited by 27 publications

References 59 publications

Warfarin prophylaxis in migraine without aura but not in primary exercise headache

Warfarin prophylaxis in migraine without aura but not in primary exercise headache

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

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