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Faisal MM, Gomaa E, Ibrahim AE, El Deeb S, Al-Harrasi A, Ibrahim TM. Verapamil-Loaded Cubosomes for Enhancing Intranasal Drug Delivery: Development, Characterization, Ex Vivo Permeation, and Brain Biodistribution Studies. AAPS PharmSciTech 2024; 25:95. [PMID: 38710921 DOI: 10.1208/s12249-024-02814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/20/2024] [Indexed: 05/08/2024] Open
Abstract
Verapamil hydrochloride (VRP), an antihypertensive calcium channel blocker drug has limited bioavailability and short half-life when taken orally. The present study was aimed at developing cubosomes containing VRP for enhancing its bioavailability and targeting to brain for cluster headache (CH) treatment as an off-label use. Factorial design was conducted to analyze the impact of different components on entrapment efficiency (EE%), particle size (PS), zeta potential (ZP), and percent drug release. Various in-vitro characterizations were performed followed by pharmacokinetic and brain targeting studies. The results revealed the significant impact of glyceryl monooleate (GMO) on increasing EE%, PS, and ZP of cubosomes with a negative influence on VRP release. The remarkable effect of Poloxamer 407 (P407) on decreasing EE%, PS, and ZP of cubosomes was observed besides its influence on accelerating VRP release%. The DSC thermograms indicated the successful entrapment of the amorphous state of VRP inside the cubosomes. The design suggested an optimized formulation containing GMO (50% w/w) and P407 (5.5% w/w). Such formulation showed a significant increase in drug permeation through nasal mucosa with high Er value (2.26) when compared to VRP solution. Also, the histopathological study revealed the safety of the utilized components used in the cubosomes preparation. There was a significant enhancement in the VRP bioavailability when loaded in cubosomes owing to its sustained release favored by its direct transport to brain. The I.N optimized formulation had greater BTE% and DTP% at 183.53% and 90.19%, respectively in comparison of 41.80% and 59% for the I.N VRP solution.
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Affiliation(s)
- Mennatullah M Faisal
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Eman Gomaa
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
| | - Adel Ehab Ibrahim
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al Mauz, P.O. Box 33, Nizwa, 616, Sultanate of Oman.
| | - Sami El Deeb
- Institute of Medicinal and Pharmaceutical Chemistry, Technische Universität Braunschweig, 38106, Brunswick, Germany.
| | - Ahmed Al-Harrasi
- Natural and Medical Sciences Research Center, University of Nizwa, Birkat Al Mauz, P.O. Box 33, Nizwa, 616, Sultanate of Oman
| | - Tarek M Ibrahim
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt
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Smedfors G, Jennysdotter Olofsgård F, Steinberg A, Waldenlind E, Ran C, Belin AC. Use of Prescribed and Non-Prescribed Treatments for Cluster Headache in a Swedish Cohort. Brain Sci 2024; 14:348. [PMID: 38672000 PMCID: PMC11048603 DOI: 10.3390/brainsci14040348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Cluster headache (CH) is a debilitating condition, but current therapies leave CH patients in pain. The extent of this problem in Sweden is unknown. METHODS An anonymized questionnaire was sent to 479 Swedish CH patients to investigate patterns and perceived effects of treatments. RESULTS Three hundred fourteen answers were analyzed. The population was representative regarding age of onset and sex. Less than half (46%) were satisfied with their abortive treatments, 19% terminated functioning abortive treatments due to side effects. Additionally, 17% of chronic CH patients had not tried the first-line preventive drug verapamil. A small subset had tried illicit substances to treat their CH (0-8% depending on substance). Notably, psilocybin was reported effective as an abortive treatment by 100% (n = 8), and with some level of effect as a preventive treatment by 92% (n = 12). For verapamil, some level of preventive effect was reported among 68% (n = 85). CONCLUSIONS Our descriptive data illustrate that many Swedish CH patients are undertreated, lack functional therapies, and experience side effects. Further studies are warranted to search for new treatment strategies as well as a revision of current treatment guidelines with the aim of reducing patient disease burden to the greatest extent possible.
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Affiliation(s)
- Gabriella Smedfors
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (G.S.); (F.J.O.); (C.R.)
| | - Felicia Jennysdotter Olofsgård
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (G.S.); (F.J.O.); (C.R.)
| | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Caroline Ran
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (G.S.); (F.J.O.); (C.R.)
| | - Andrea Carmine Belin
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (G.S.); (F.J.O.); (C.R.)
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3
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Ciciarelli MC, Simioni CVDMG, Londero RG. Headaches in adults in supplementary health: management. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e023D701. [PMID: 38511747 PMCID: PMC10941913 DOI: 10.1590/1806-9282.023d701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 03/22/2024]
Affiliation(s)
| | | | - Renata Gomes Londero
- Brazilian Academy of Neurology, Porto Alegre Clinical Hospital – Porto Alegre (RS), Brazil
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Medrea I, Tepper SJ, Wang D, Mathew PG, Burish M. Commentary on 2022 guidelines on clinical trial design in cluster headache and further suggestions. J Headache Pain 2024; 25:32. [PMID: 38454380 PMCID: PMC10921584 DOI: 10.1186/s10194-024-01732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND New guidelines for cluster headache clinical trials were recently published. We welcome these new guidelines and raise additional considerations in trial methodologies. MAIN BODY We present non-inferiority trials to overcome ethical issues with placebo use, and additionally discuss issues with trial recruitment. CONCLUSIONS We highlight some possible issues and solutions to be considered with the recently published cluster headache trial guidelines.
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Affiliation(s)
- Ioana Medrea
- SUNY Upstate Medical University, Syracuse, New York, USA.
| | - Stewart J Tepper
- The New England Institute for Neurology and Headache, 30 Buxton Farms Rd, Stamford, CT, USA
| | - Donliang Wang
- SUNY Upstate Medical University, Syracuse, New York, USA
| | - Paul G Mathew
- Harvard Medical School, Boston, MA, USA
- Mass General Brigham Health, Department of Neurology, Foxboro, MA, USA
- Atrius Health, Department of Neurology, Quincy, MA, USA
| | - Mark Burish
- UTHealth Houston, Department of Neurosurgery, Houston, TX, USA
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Jensen RH, Tassorelli C, Myers Oakes TM, Bardos JN, Zhou C, Dong Y, Aurora SK, Martinez JM. Baseline demographics and disease characteristics of patients with episodic or chronic cluster headache: data from two phase 3 randomized clinical trials in Europe and North America. Front Neurol 2023; 14:1293163. [PMID: 38162453 PMCID: PMC10756139 DOI: 10.3389/fneur.2023.1293163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Two phase 3 galcanezumab trials were conducted in Europe and North America to analyze the reduction of weekly cluster headache (CH) attack frequency in populations with episodic and chronic CH. The current study aims to illustrate prospectively recorded baseline clinical data from these trials and to identify possible predictors of response. Methods Patients (aged 18-65 years) met The International Classification of Headache Disorders 3rd edition-beta criteria for CH. Attacks were evaluated using an electronic headache diary for 7-day (episodic) or 14-day (chronic) eligibility assessments before patients were randomized 1:1 to monthly subcutaneous galcanezumab 300 mg or placebo. Results Data were collected from 106 patients with episodic and 237 with chronic CH. Overall, the mean age [standard deviation] was 45.4 [11.0] years; patients were predominantly White (84.5%), male (75.8%), and European (77.6%). Patients with episodic CH reported 17.5 [10.0] attacks/week; patients with chronic CH reported 18.8 [10.2] attacks/week. The average pain severity score (range 0-4) was 2.5 [0.7] for episodic CH and 2.7 [0.7] for chronic CH. Higher attack frequency was a possible predictor of response to galcanezumab; potential negative predictors of response were greater attack severity and duration. Conclusion This large dataset of patients with CH provides reliable systematically and prospectively collected information on disease characteristics. The analysis in episodic CH underscores potential predictors of response worth considering for future CH trial design. Clinical Trial Registration ClinicalTrials.gov, identifiers: NCT02397473 and NCT02438826.
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Affiliation(s)
- Rigmor Hoejland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Tina M. Myers Oakes
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
| | - Jennifer N. Bardos
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
| | - Chunmei Zhou
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
| | - Yan Dong
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
| | - Sheena K. Aurora
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
| | - James M. Martinez
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, United States
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Rodriguez-Leyva I, Velez-Jimenez MK, García S, Nader-Kawachi JA, Martínez-Mayorga AP, Melo-Carrillo A, Juárez-Jimenez H, Martinez-Gurrola M, Gudiño-Castelazo M, Chiquete E, Villareal-Careaga J, Marfil A, Uribe-Jaimes PD, Vargas-García RD, Collado-Ortiz MA, San-Juan D. Cluster headache: state of the art in treatment. FRONTIERS IN PAIN RESEARCH 2023; 4:1265540. [PMID: 37965210 PMCID: PMC10641784 DOI: 10.3389/fpain.2023.1265540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
Cluster headache (CH) is the most common and devastating autonomic headache with multiple and recent advances in treatment. However, it usually goes unrecognized and is found to have a delayed and inappropriate treatment. This paper aims to review the current therapeutic options for patients with CH. We conducted a narrative literature review on the treatments available for this condition using the American Academy of Neurology (AAN) classification of therapeutic evidence. We found effective and safe pharmacological and non-pharmacological therapies with heterogeneity of clinical trial designs for patients with CH, and they are divided into three phases, namely, transitional, acute, and preventive interventions. Prednisone (A) is the most studied treatment in the transitional phase; acute attacks are treated using triptans (A), oxygen (A), and non-invasive transcutaneous vagal nerve stimulation (A). Verapamil (A) and monoclonal antibodies (possible A) are considered the first options in preventive treatments, followed by multiple pharmacological and non-pharmacological options in prophylactic treatments. In conclusion, numerous effective and safe treatments are available in treating patients with episodic, chronic, and pharmacoresistant CH according to the clinical profile of each patient.
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Affiliation(s)
- Ildefonso Rodriguez-Leyva
- Department of Neurology, Faculty of Medicine, Central Hospital “Dr. Ignacio Morones Prieto,”Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
| | | | - Silvia García
- Clinical Research Department, Centro Médico Nacional “20 de Noviembre,” ISSSTE, Mexico City, Mexico
| | | | | | - Agustín Melo-Carrillo
- Anesthesia Department, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | | | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán,”Mexico City, Mexico
| | | | - Alejandro Marfil
- Headache and Chronic Pain Clinic, Neurology Service, Hospital Universitario “Dr. J. E. González” of the Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
| | | | | | | | - Daniel San-Juan
- Epilepsy Clinic of the National Institute of Neurology and Neurosurgery Manuel Velazco Suarez, Mexico City, Mexico
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May A, Evers S, Goadsby PJ, Leone M, Manzoni GC, Pascual J, Carvalho V, Romoli M, Aleksovska K, Pozo-Rosich P, Jensen RH. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol 2023; 30:2955-2979. [PMID: 37515405 DOI: 10.1111/ene.15956] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. METHODS The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RECOMMENDATIONS For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.
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Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Stefan Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
- Faculty of Medicine, University of Münster, Münster, Germany
| | - Peter J Goadsby
- NIHR King's CRF, SLaM Biomedical Research Centre, King's College London, London, UK
| | - Massimo Leone
- Neuroalgology Department, Foundation of the Carlo Besta Neurological Institute, IRCCS, Milan, Italy
| | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain
| | - Vanessa Carvalho
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Michele Romoli
- Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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Lund NLT, Petersen AS, Fronczek R, Tfelt-Hansen J, Belin AC, Meisingset T, Tronvik E, Steinberg A, Gaul C, Jensen RH. Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments-a consensus article. J Headache Pain 2023; 24:121. [PMID: 37667192 PMCID: PMC10476341 DOI: 10.1186/s10194-023-01660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023] Open
Abstract
AIM Treatment for cluster headache is currently based on a trial-and-error approach. The available preventive treatment is unspecific and based on few and small studies not adhering to modern standards. Therefore, the authors collaborated to discuss acute and preventive treatment in cluster headache, addressing the unmet need of safe and tolerable preventive medication from the perspectives of people with cluster headache and society, headache specialist and cardiologist. FINDINGS The impact of cluster headache on personal life is substantial. Mean annual direct and indirect costs of cluster headache are more than 11,000 Euros per patient. For acute treatment, the main problems are treatment response, availability, costs and, for triptans, contraindications and the maximum use allowed. Intermediate treatment with steroids and greater occipital nerve blocks are effective but cannot be used continuously. Preventive treatment is sparsely studied and overall limited by relatively low efficacy and side effects. Neurostimulation is a relevant option for treatment-refractory chronic patients. From a cardiologist's perspective use of verapamil and triptans may be worrisome and regular follow-up is essential when using verapamil and lithium. CONCLUSION We find that there is a great and unmet need to pursue novel and targeted preventive modalities to suppress the horrific pain attacks for people with cluster headache.
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Affiliation(s)
- Nunu Laura Timotheussen Lund
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.
- Department of Neurology, Sjællands Universitetshospital Roskilde, Roskilde, Denmark.
| | - Anja Sofie Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederlands (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Andrea Carmine Belin
- Centre for Cluster Headache, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tore Meisingset
- Norwegian Advisory Unit On Headaches, St. Olav University Hospital, Trondheim, Norway
- NorHEAD, Norwegian Headache Research Centre, NTNU, Trondheim, Norway
| | - Erling Tronvik
- Norwegian Advisory Unit On Headaches, St. Olav University Hospital, Trondheim, Norway
- NorHEAD, Norwegian Headache Research Centre, NTNU, Trondheim, Norway
| | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Charly Gaul
- Charly Gaul, Headache Center, Frankfurt, Germany
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
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Peng KP, Burish MJ. Management of cluster headache: Treatments and their mechanisms. Cephalalgia 2023; 43:3331024231196808. [PMID: 37652457 DOI: 10.1177/03331024231196808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The management of cluster headache is similar to that of other primary headache disorders and can be broadly divided into acute and preventive treatments. Acute treatments for cluster headache are primarily delivered via rapid, non-oral routes (such as inhalation, nasal, or subcutaneous) while preventives include a variety of unrelated treatments such as corticosteroids, verapamil, and galcanezumab. Neuromodulation is becoming an increasingly popular option, both non-invasively such as vagus nerve stimulation when medical treatment is contraindicated or side effects are intolerable, and invasively such as occipital nerve stimulation when medical treatment is ineffective. Clinically, this collection of treatment types provides a range of options for the informed clinician. Scientifically, this collection provides important insights into disease mechanisms. METHODS Two authors performed independent narrative reviews of the literature on guideline recommendations, clinical trials, real-world data, and mechanistic studies. RESULTS Cluster headache is treated with acute treatments, bridge treatments, and preventive treatments. Common first-line treatments include subcutaneous sumatriptan and high-flow oxygen as acute treatments, corticosteroids (oral or suboccipital injections) as bridge treatments, and verapamil as a preventive treatment. Some newer acute (non-invasive vagus nerve stimulation) and preventive (galcanezumab) treatments have excellent clinical trial data for episodic cluster headache, while other newer treatments (occipital nerve stimulation) have been specifically tested in treatment-refractory chronic cluster headache. Most treatments are suspected to act on the trigeminovascular system, the autonomic system, or the hypothalamus. CONCLUSIONS The first-line treatments have not changed in recent years, but new treatments have provided additional options for patients.
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Affiliation(s)
- Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mark J Burish
- Department of Neurosurgery, UTHealth Houston, Houston, Texas, USA
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Søborg MLK, Petersen AS, Lund N, Wandall-Holm MF, Jensen RH, Barloese M. Transition of cluster headache phenotype: An interview-based study. Cephalalgia 2023; 43:3331024221128287. [PMID: 36587291 DOI: 10.1177/03331024221128287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Cluster headache exists diagnostically in a chronic and episodic variant between which patients can convert. We aimed to describe how many patients change phenotype, elucidate possible factors associated with this transition and identify differences in clinical features between primary and secondary phenotypes.Methods 540 well-defined cluster headache patients according to current ICHD-criteria completed a cross-sectional semi-structured interview.Results Total transition-incidence for the cohort was 20.7%. Conversion from chronic to episodic was reported by 6.3% and transition from episodic to chronic by 14.4% with attack side shift as a possible predictor (p = 0.007). Compared to primary chronic patients, secondary chronic patients had more frequent (60 vs 34 per month, p = 0.0487), but shorter (60 vs 90 minutes, p = 0.041) attacks. Secondary episodic patients experienced shorter remission periods than primary episodic patients (6 vs 11 months, p = 0.010). Treatment response was poor in all groups and only one third had effective prevention.Conclusion Cluster headache is a fluctuating disorder with a fifth of our cohort having experienced at least one phenotype change during course of disease. Apart from attack side shifts, no predictors for transition were identified. Severity differed between primary and secondary subtypes. Overall, there is an urgent need for better understanding of cluster headache.
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Affiliation(s)
- Marie-Louise Kulas Søborg
- The Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anja Sofie Petersen
- The Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Nunu Lund
- The Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Malthe Faurschou Wandall-Holm
- The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- The Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mads Barloese
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
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Elser H, Rowland ST, Marek MS, Kiang MV, Shea B, Do V, Benmarhnia T, Schneider ALC, Casey JA. Wildfire smoke exposure and emergency department visits for headache: A case-crossover analysis in California, 2006-2020. Headache 2023; 63:94-103. [PMID: 36651537 PMCID: PMC10066880 DOI: 10.1111/head.14442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the association of short-term exposure to overall fine particulate matter of <2.5 μm (PM2.5 ) and wildfire-specific PM2.5 with emergency department (ED) visits for headache. BACKGROUND Studies have reported associations between PM2.5 exposure and headache risk. As climate change drives longer and more intense wildfire seasons, wildfire PM2.5 may contribute to more frequent headaches. METHODS Our study included adult Californian members (aged ≥18 years) of a large de-identified commercial and Medicare Advantage claims database from 2006 to 2020. We identified ED visits for primary headache disorders (subtypes: tension-type headache, migraine headache, cluster headache, and "other" primary headache). Claims included member age, sex, and residential zip code. We linked daily overall and wildfire-specific PM2.5 to residential zip code and conducted a time-stratified case-crossover analysis considering 7-day average PM2.5 concentrations, first for primary headache disorders combined, and then by headache subtype. RESULTS Among 9898 unique individuals we identified 13,623 ED encounters for primary headache disorders. Migraine was the most frequently diagnosed headache (N = 5534/13,623 [47.6%]) followed by "other" primary headache (N = 6489/13,623 [40.6%]). For all primary headache ED diagnoses, we observed an association of 7-day average wildfire PM2.5 (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.95-1.44 per 10 μg/m3 increase) and by subtype we observed increased odds of ED visits associated with 7-day average wildfire PM2.5 for tension-type headache (OR 1.42, 95% CI 0.91-2.22), "other" primary headache (OR 1.40, 95% CI 0.96-2.05), and cluster headache (OR 1.29, 95% CI 0.71-2.35), although these findings were not statistically significant under traditional null hypothesis testing. Overall PM2.5 was associated with tension-type headache (OR 1.29, 95% CI 1.03-1.62), but not migraine, cluster, or "other" primary headaches. CONCLUSIONS Although imprecise, these results suggest short-term wildfire PM2.5 exposure may be associated with ED visits for headache. Patients, healthcare providers, and systems may need to respond to increased headache-related healthcare needs in the wake of wildfires and on poor air quality days.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Population Health Sciences, Stanford University, Stanford, California, USA
| | - Sebastian T Rowland
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA.,PSE Healthy Energy, Oakland, New York, USA
| | - Maksym S Marek
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew V Kiang
- Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Brittany Shea
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Vivian Do
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - Andrea L C Schneider
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joan A Casey
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York, USA
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12
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Al-Karagholi MAM, Peng KP, Petersen AS, De Boer I, Terwindt GM, Ashina M. Debate: Are cluster headache and migraine distinct headache disorders? J Headache Pain 2022; 23:151. [PMID: 36447146 PMCID: PMC9706960 DOI: 10.1186/s10194-022-01504-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Cluster headache and migraine are regarded as distinct primary headaches. While cluster headache and migraine differ in multiple aspects such as gender-related and headache specific features (e.g., attack duration and frequency), both show clinical similarities in trigger factors (e.g., alcohol) and treatment response (e.g., triptans). Here, we review the similarities and differences in anatomy and pathophysiology that underlie cluster headache and migraine, discuss whether cluster headache and migraine should indeed be considered as two distinct primary headaches, and propose recommendations for future studies. Video recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at https://www.youtube.com/watch?v=uUimmnDVTTE .
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Affiliation(s)
- Mohammad Al-Mahdi Al-Karagholi
- grid.5254.60000 0001 0674 042XDanish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, DK-2600 Glostrup, Denmark
| | - Kuan-Po Peng
- grid.13648.380000 0001 2180 3484Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Sofie Petersen
- grid.5254.60000 0001 0674 042XDanish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, DK-2600 Glostrup, Denmark
| | - Irene De Boer
- grid.10419.3d0000000089452978Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Gisela M. Terwindt
- grid.10419.3d0000000089452978Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Messoud Ashina
- grid.5254.60000 0001 0674 042XDanish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansen Vej 5, DK-2600 Glostrup, Denmark
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13
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Rusanen SS, De S, Schindler EAD, Artto VA, Storvik M. Self-Reported Efficacy of Treatments in Cluster Headache: a Systematic Review of Survey Studies. Curr Pain Headache Rep 2022; 26:623-637. [PMID: 35759175 PMCID: PMC9436841 DOI: 10.1007/s11916-022-01063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The use and efficacy of various substances in the treatment of CH have been studied in several retrospective surveys. The aim of the study is to systematically review published survey studies to evaluate the reported efficacies of both established and unconventional substances in abortive and prophylactic treatment of both episodic and chronic CH, specifically assessing the consistency of the results. RECENT FINDINGS No systematic review have been conducted of these studies previously. A systematic literature search with a set of search terms was conducted on PubMed. Retrospective surveys that quantified the self-reported efficacy of two or more CH treatments, published in English during 2000-2020, were included. Several key characteristics and results of the studies were extracted. A total of 994 articles were identified of which 9 were found to be eligible based on the selection criteria. In total, 5419 respondents were included. Oxygen and subcutaneous triptan injections were most reported as effective abortive treatments, while psilocybin and lysergic acid diethylamide were most commonly reported as effective prophylactic treatments. The reported efficacy of most substances was consistent across different studies, and there were marked differences in the reported efficacies of different substances. The reported order of efficacy is generally in agreement with clinical studies. The findings suggest that retrospective surveys can be used to obtain supporting information on the effects of various substances used in the treatment of CH and to form hypotheses about novel treatment methods. The consistently reported efficacy of psilocybin and LSD in prophylactic treatment indicates need for clinical studies.
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Affiliation(s)
| | - Suchetana De
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | - Ville Aleksi Artto
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markus Storvik
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
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14
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Dodick DW, Goadsby PJ, Ashina M, Tassorelli C, Hundemer HP, Bardos JN, Wenzel Md R, Kemmer P, Conley R, Martinez JM, Oakes T. Challenges and complexities in designing cluster headache prevention clinical trials: A narrative review. Headache 2022; 62:453-472. [PMID: 35363381 PMCID: PMC9325511 DOI: 10.1111/head.14292] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
Objective To provide a review of challenges in clinical trials for the preventive treatment of cluster headache (CH) and highlight considerations for future studies. Background Current guidelines for preventive treatment of CH are largely based on off‐label therapies supported by a limited number of small randomized controlled trials. Guidelines for clinical trial design for CH treatments from the International Headache Society were last issued in 1995. Methods/Results Randomized controlled clinical trials were identified in the European and/or United States clinical trial registries with a search term of “cluster headache,” and manually reviewed. Cumulatively, there were 27 unique placebo‐controlled prevention trials for episodic and/or chronic CH, of which 12 were either ongoing, not yet recruiting, or the status was unknown. Of the remaining 15 trials, 5 were terminated early and 7 of the 10 completed trials enrolled fewer patients than planned or did not report the planned sample size. A systematic search of PubMed was also utilized to identify published manuscripts reporting results from placebo‐controlled preventive trials of CH. This search yielded 16 publications, of which 7 were registered. Through critical review of trial data and published manuscripts, challenges and complexities encountered in clinical trials for the preventive treatment of CH were identified. For example, the excruciating pain associated with CH demands a suitably limited baseline duration, rapid treatment efficacy onset, and poses a specific issue regarding duration of investigational treatment period and length of exposure to placebo. In episodic CH, spontaneous remission as part of natural history, and the unpredictability and irregularity of cluster periods across patients present additional key challenges. Conclusions Optimal CH trial design should balance sound methodology to demonstrate efficacy of a potential treatment with patient needs and the natural history of the disease, including unique outcome measures and endpoint timings for chronic versus episodic CH.
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Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Peter J Goadsby
- National Institute for Health Research (NIHR) Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.,Department of Neurology, University of California, Los Angeles, California, USA
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Phebe Kemmer
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Robert Conley
- Eli Lilly and Company, Indianapolis, Indiana, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Tina Oakes
- Eli Lilly and Company, Indianapolis, Indiana, USA
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15
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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).
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Veterans Health Administration Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Mark J Burish
- Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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16
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Comparative Impact of Pharmacological Therapies on Cluster Headache Management: A Systematic Review and Network Meta-Analysis. J Clin Med 2022; 11:jcm11051411. [PMID: 35268502 PMCID: PMC8911224 DOI: 10.3390/jcm11051411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 12/10/2022] Open
Abstract
It is important to find effective and safe pharmacological options for managing cluster headache (CH) because there is limited evidence from studies supporting the general efficacy and safety of pharmacological therapies. This systematic review and network meta-analysis (NMA) analyzed published randomized controlled trials (RCTs) to evaluate the efficacy and safety of pharmacological treatments in patients with CH. The PubMed and Embase databases were searched to identify RCTs that evaluated the efficacy and safety of pharmacological treatments for CH. Efficacy outcomes included frequency and duration of attacks, pain-free rate, and the use of rescue agents. Safety outcomes were evaluated based on the number of patients who experienced adverse events. A total of 23 studies were included in the analysis. The frequency of attacks was reduced (mean difference (MD) = −1.05, 95% confidence interval (CI) = −1.62 to −0.47; p = 0.0004), and the pain-free rate was increased (odds ratio (OR) = 3.89, 95% CI = 2.76−5.48; p < 0.00001) in the pharmacological treatment group, with a lower frequency of rescue agent use than the placebo group. Preventive, acute, and triptan or non-triptan therapies did not show significant differences in efficacy (p > 0.05). In the NMA, different results were shown among the interventions; for example, zolmitriptan 5 mg was more effective than zolmitriptan 10 mg in the pain-free outcome (OR = 0.40, 95% CI = 0.19−0.82; p < 0.05). Pharmacological treatment was shown to be more effective than placebo to manage CH with differences among types of therapies and individual interventions, and it was consistently shown to be associated with the development of adverse events. Thus, individualized therapy approaches should be applied to treat CH in real-world practice.
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17
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Medrea I, Christie S, Tepper SJ, Thavorn K, Hutton B. Effects of acute and preventive therapies for episodic and chronic cluster headache: A scoping review of the literature. Headache 2022; 62:329-362. [PMID: 35315067 DOI: 10.1111/head.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cluster headache is the most common primary headache disorder of the trigeminal autonomic cephalalgias, and it is highly disabling. OBJECTIVE We undertake a scoping review to characterize therapies to prevent and acutely treat cluster headache, characterize trial methodology utilized in studies, and recommend future trial "good practices." We also assess homogeneity of studies and feasibility for future network meta-analyses (NMAs) to compare acute and preventive treatments for cluster headache. METHODS A priori protocol for this scoping review was registered and available on Open Science Forum. We sought studies that enrolled adult patients with cluster headache as identified by accepted diagnostic criteria. Both randomized controlled trials (RCTs) and observational studies (with a control group) were included. The interventions of interest were medications, procedures, devices, surgeries, and behavioral/psychological interventions, whereas comparators of interest were placebo, sham, or other active treatments. Outcomes were predefined; however, we did not exclude studies lacking these outcomes. A systemic search was conducted in Ovid Medline, Embase, and Cochrane. We performed a targeted search for conference abstracts from journals prominent in the field. RESULTS We identified 56 studies: 45 RCTs, four studies only available in clinical trial registries, and seven observational studies. Of the 45 RCTs, 20 focused on acute therapies and 25 on preventive therapies. Overall, we determined that it is feasible to pursue a NMA for acute therapy focusing on 15 or 30-min headache reduction for acute trials, as we identified 11 trials in the combined population of patients with either episodic or chronic cluster headache (2 trials in populations with chronic cluster headache were also found). For preventive therapy of cluster headache, we identified trials with common outcomes that may be considered for NMA, however, as these trials had differences in treatment effect modifiers that could not be corrected, NMAs appear infeasible for this indication. We identified new studies looking at noninvasive vagal nerve stimulation, sphenopalatine ganglion stimulation, prednisone, and oxygen published since the most recent systematic review in the field, although these acute treatments were previously identified as effective. However, for calcitonin gene-related peptide (CGRP) monoclonal antibodies, galcanezumab demonstrated effectiveness in episodic cluster headache, but a lack of effectiveness in chronic cluster headache, and fremanezumab was not effective for episodic nor chronic cluster headache. This finding highlights that CGRP monoclonal antibodies may not show a class effect in cluster headache prevention and need to be considered individually. CONCLUSIONS We describe the treatment landscape of cluster headache for both acute and preventive treatments. Last, we present the NMAs we will undertake in acute therapies of cluster headache.
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Affiliation(s)
- Ioana Medrea
- University of Ottawa Ottawa Ontario Canada
- SUNY Upstate Medical University Syracuse New York USA
| | - Suzanne Christie
- University of Ottawa Ottawa Ontario Canada
- Ottawa Headache Centre Ottawa Ontario Canada
| | | | - Kednapa Thavorn
- University of Ottawa Ottawa Ontario Canada
- Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Brian Hutton
- University of Ottawa Ottawa Ontario Canada
- Ottawa Hospital Research Institute Ottawa Ontario Canada
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18
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Cho S, Cho SJ, Lee MJ, Park JW, Chu MK, Moon HS, Chung PW, Sohn JH, Kim BS, Kim D, Kim JM, Chung JM, Oh K, Ahn JY, Gil YE, Chung CS, Kim BK. Characteristics of pre-cluster symptoms in cluster headache: A cross-sectional multicentre study. Cephalalgia 2022; 42:570-578. [PMID: 35112933 DOI: 10.1177/03331024211067784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Contrary to pre-attack symptoms before an individual cluster headache attack, little is known about the pre-cluster symptoms before the onset of cluster bouts. We previously described pre-attack symptoms before cluster headache attacks. The aim of this study was to investigate characteristics of pre-cluster symptoms in patients with episodic cluster headache. METHODS In this multicentre study, 184 patients with episodic cluster headache were recruited between October 2018 and December 2020. They were interviewed by investigators and completed a structured questionnaire. To investigate pre-cluster and pre-attack symptoms, we assessed 20 symptoms and signs using the questionnaire. RESULTS The upcoming cluster bout was predictable in 35.3% (n = 65/184) of the patients. When present, pre-cluster symptoms occurred at a median duration of 7 days (interquartile range, 2.3-14 days) before the onset of the cluster bout. Patients with pre-cluster symptoms showed a higher proportion of women, prevalence of pre-attack symptoms and seasonal rhythmicity, frequency of cluster headache attacks per day, and total number of cluster bouts compared to patients without pre-cluster symptoms. In univariable and multivariable logistic regression analyses, female sex was associated with the predictability of pre-cluster symptoms (odds ratio = 2.297, p = 0.016). CONCLUSIONS The upcoming cluster bout was predicted in approximately 35% of patients with episodic cluster headache, which may allow for an earlier preventive treatment and help understand the pathophysiology.
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Affiliation(s)
- Soohyun Cho
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Young Eun Gil
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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19
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Prasad S, Mehadi A, Kaka N, Jhaveri S, Avanthika C, Patel N, Augustine I, Issani A. Diagnostic protocols and newer treatment modalities for cluster headache. Dis Mon 2022; 68:101316. [PMID: 35000758 DOI: 10.1016/j.disamonth.2021.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cluster Headaches are one of the most arguably severe forms of primary headache syndrome that affects humans. Although it is relatively uncommon, it has a significant impact on the quality of life. It is a multifactorial disease that has risk factors ranging from seasonal changes, lifestyle habits to genetics. It occurs in 2 forms- Episodic and Chronic, each having its well-defined Diagnostic Criteria. Moreover, Cluster Headache has an exhaustive list of options for both Preventive and Abortive treatment. This article focuses on Cluster Headache, its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an all-language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till October 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: "Cluster Headache," "Triptans," "Neuromodulation," and "Migraine." We explored the literature on Cluster Headache for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease as well as its episodic and chronic variants, and treatment options. Although we have a wide variety of options for Preventive and Abortive therapy, newer more effective pharmacological and non-pharmacological interventions are being developed, and must be integrated into new treatment protocols.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov, Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | - Nirja Kaka
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Sharan Jhaveri
- Smt. NHL Municipal Medical college, Ahmedabad 380006, India.
| | - Chaithanya Avanthika
- Karnataka Institute of Medical Sciences,PB Road, Hubli 580022, Karnataka, India.
| | - Neil Patel
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Ivan Augustine
- Government Medical college Thrissur 680596, Kerala,India.
| | - Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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20
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Abstract
Cluster headache belongs to the group of trigeminal autonomic headaches. This review summarizes drug therapy of cluster attacks and prophylactic treatment. Neurostimulation methods are not addressed. The therapy for acute cluster attacks includes inhalation of 100% oxygen, subcutaneous administration of sumatriptan, and intranasal application of sumatriptan or zolmitriptan. Bridging therapy, which is used until oral prophylactic therapy is effective, is performed either with oral prednisolone or with a pharmacological block of the major occipital nerves. Best documented drugs for preventive treatment of cluster headache are verapamil and lithium, and possibly effective drugs are gabapentin, topiramate, divalproex sodium, and melatonin. The efficacy of monoclonal antibodies to the calcitonin gene-related peptide so far has been only demonstrated for episodic cluster headache. Several drug therapies are being investigated including ketamine, onabotulinumtoxinA, lysergic acid, and sodium oxybate.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Arne May
- Department of Systems Neuroscience, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
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21
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Tuncer Issı Z, Akbulut N, Öztürk V. Cluster headache: a single tertiary center study. Neurol Res 2021; 44:342-352. [PMID: 34781845 DOI: 10.1080/01616412.2021.1992101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECT The characteristics of cluster headache (CH) patients in many countries and the diagnostic and therapeutic approach have been described in several publications, but so far no clinical data have been published from Turkey. MATERIAL METHODS This is a cross-sectional retrospective study that includes all patients who were diagnosed with CH and referred to our headache clinic, Dokuz Eylül University Faculty of Medicine, Neurology Department from 1991 to January 2018. RESULTS We included 114 patients (24 females and 90 males) in our study. The mean age at onset was 31.68 ± 12.72 (range 13-68). Eighty-six (78.18%) patients had episodic cluster headache (ECH) and 24 (21.82%) patients had chronic cluster headache (CCH). The age at onset was significantly higher in the patients with CCH than with ECH (p = 0.002). The most common location was orbitotemporal for both genders. The most common accompanying symptoms were lacrimation (80.73%). The male:female ratio in all patients was 3:7, 3.8:1 in those with CCH and 4:1 in those with ECH. Eighty-nine (87.25%) patients had prophylactic treatment and 60 of them received verapamil. CONCLUSION In our study, some clinical features of our patients were similar to those of Europe and America or the Asian countries and some of them not. There are regional differences in cluster headache patients. With more awareness of cluster headache and research from many countries, clinical differences can be revealed more objectively in the future.
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Affiliation(s)
- Zeynep Tuncer Issı
- Department of Pain Management, Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Nurcan Akbulut
- Department of Neurology, Bayburt State Hospital, Bayburt, Turkey
| | - Vesile Öztürk
- Faculty of Medicine Hospital, Department of Neurology, Dokuz Eylül University, Izmir, Turkey
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22
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Frimpong EK, Asong JA, Aremu AO. A Review on Medicinal Plants Used in the Management of Headache in Africa. PLANTS 2021; 10:plants10102038. [PMID: 34685845 PMCID: PMC8539318 DOI: 10.3390/plants10102038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 01/29/2023]
Abstract
The use of medicinal plants in the management of diverse ailments is entrenched in the culture of indigenous people in African communities. This review provides a critical appraisal of the ethnobotanical uses of medicinal plants for the management of headache in Africa. Research articles published from 2010 (Jan) to 2021 (July) with keywords such as Africa, ethnobotany, headache, medicinal plant and traditional medicine were assessed for eligibility based on sets of pre-defined criteria. A total of 117 plants, representing 56 families, were documented from the 87 eligible studies. Asteraceae (10%), Fabaceae (10%), Lamiaceae (9%) and Mimosaceae (5%) were the most represented plant families. The most popular plant species used in the management of headache were Ocimum gratissimum L. (n = 7), Allium sativum L. (n = 3), Ricinus communis L. (n = 3) and Artemisia afra Jack. ex. Wild (n = 2). The leaves (49%), roots (20%) and bark (12%) were the most common plant parts used. Decoction (40%) and infusion (16%) were the preferred methods of preparation, whereas the oral route (52%) was the most preferred route of administration. The data revealed that medicinal plants continue to play vital roles in the management of headache in African communities. In an attempt to fully explore the benefits from the therapeutic potential of indigenous flora for common ailments, further studies are essential to generate empirical evidence on their efficacies, using appropriate test systems/models. This approach may assist with the ongoing drive towards the integration of African traditional medicine within mainstream healthcare systems.
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Affiliation(s)
- Ebenezer Kwabena Frimpong
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
- Correspondence: (E.K.F.); (A.O.A.); Tel.: +27-18-389-2573 (A.O.A.)
| | - John Awungnjia Asong
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
| | - Adeyemi Oladapo Aremu
- Indigenous Knowledge Systems Centre, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa;
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2790, South Africa
- Correspondence: (E.K.F.); (A.O.A.); Tel.: +27-18-389-2573 (A.O.A.)
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23
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O'Connor E, Fourier C, Ran C, Sivakumar P, Liesecke F, Southgate L, Harder AVE, Vijfhuizen LS, Yip J, Giffin N, Silver N, Ahmed F, Hostettler IC, Davies B, Cader MZ, Simpson BS, Sullivan R, Efthymiou S, Adebimpe J, Quinn O, Campbell C, Cavalleri GL, Vikelis M, Kelderman T, Paemeleire K, Kilbride E, Grangeon L, Lagrata S, Danno D, Trembath R, Wood NW, Kockum I, Winsvold BS, Steinberg A, Sjöstrand C, Waldenlind E, Vandrovcova J, Houlden H, Matharu M, Belin AC. Genome-Wide Association Study Identifies Risk Loci for Cluster Headache. Ann Neurol 2021; 90:193-202. [PMID: 34184781 DOI: 10.1002/ana.26150] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study was undertaken to identify susceptibility loci for cluster headache and obtain insights into relevant disease pathways. METHODS We carried out a genome-wide association study, where 852 UK and 591 Swedish cluster headache cases were compared with 5,614 and 1,134 controls, respectively. Following quality control and imputation, single variant association testing was conducted using a logistic mixed model for each cohort. The 2 cohorts were subsequently combined in a merged analysis. Downstream analyses, such as gene-set enrichment, functional variant annotation, prediction and pathway analyses, were performed. RESULTS Initial independent analysis identified 2 replicable cluster headache susceptibility loci on chromosome 2. A merged analysis identified an additional locus on chromosome 1 and confirmed a locus significant in the UK analysis on chromosome 6, which overlaps with a previously known migraine locus. The lead single nucleotide polymorphisms were rs113658130 (p = 1.92 × 10-17 , odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.37-1.66) and rs4519530 (p = 6.98 × 10-17 , OR = 1.47, 95% CI = 1.34-1.61) on chromosome 2, rs12121134 on chromosome 1 (p = 1.66 × 10-8 , OR = 1.36, 95% CI = 1.22-1.52), and rs11153082 (p = 1.85 × 10-8 , OR = 1.30, 95% CI = 1.19-1.42) on chromosome 6. Downstream analyses implicated immunological processes in the pathogenesis of cluster headache. INTERPRETATION We identified and replicated several genome-wide significant associations supporting a genetic predisposition in cluster headache in a genome-wide association study involving 1,443 cases. Replication in larger independent cohorts combined with comprehensive phenotyping, in relation to, for example, treatment response and cluster headache subtypes, could provide unprecedented insights into genotype-phenotype correlations and the pathophysiological pathways underlying cluster headache. ANN NEUROL 2021;90:193-202.
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Affiliation(s)
- Emer O'Connor
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Neurogenetics Laboratory, Institute of Neurology, University College London, London, UK.,Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Fourier
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Prasanth Sivakumar
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | | | - Laura Southgate
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Medical & Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Aster V E Harder
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisanne S Vijfhuizen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Janice Yip
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Nicola Giffin
- Neurology Department, Royal United Hospital, Bath, UK
| | | | - Fayyaz Ahmed
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Isabel C Hostettler
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Brendan Davies
- Department of Neurology, University Hospital North Midlands National Health Service Trust, Stoke-on-Trent, UK
| | - M Zameel Cader
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Benjamin S Simpson
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Roisin Sullivan
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Joycee Adebimpe
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Olivia Quinn
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Ciaran Campbell
- Science Foundation Ireland FutureNeuro Research Centre, Royal College of Surgeons, Ireland School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland Dublin, Dublin, Ireland
| | - Gianpiero L Cavalleri
- Science Foundation Ireland FutureNeuro Research Centre, Royal College of Surgeons, Ireland School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland Dublin, Dublin, Ireland
| | | | - Tim Kelderman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Lou Grangeon
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Rouen University Hospital, Rouen, France
| | - Susie Lagrata
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Daisuke Danno
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Richard Trembath
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Nicholas W Wood
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.,Neurogenetics Laboratory, Institute of Neurology, University College London, London, UK
| | - Ingrid Kockum
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Bendik S Winsvold
- Department of Research, Innovation, and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Anna Steinberg
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Christina Sjöstrand
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Waldenlind
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jana Vandrovcova
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Andrews JS, Kudrow D, Rettiganti M, Oakes T, Bardos JN, Wenzel R, Kuruppu DK, Gaul C, Martinez JM. Impact of Galcanezumab on Total Pain Burden: A Post Hoc Analysis of a Phase 3, Randomized, Double-Blind, Placebo-Controlled Study in Patients with Episodic Cluster Headache. J Pain Res 2021; 14:2059-2070. [PMID: 34267550 PMCID: PMC8275210 DOI: 10.2147/jpr.s305066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose In a phase 3 study, galcanezumab significantly reduced the frequency of episodic cluster headache attacks across weeks 1–3 (primary endpoint) compared with placebo. However, multiple pain dimensions may contribute to the total burden of episodic cluster headache pain. This post hoc analysis assessed the impact of galcanezumab on the total pain burden of episodic cluster headache using a composite measure. Patients and Methods Patients with episodic cluster headache were randomized 1:1 to galcanezumab 300 mg or placebo once monthly for 8 weeks. Mean weekly total pain burden was calculated (daily cluster headache attack frequency × average duration × average pain severity summed over 7 days) using data collected in an electronic patient-reported outcomes diary. Change from baseline in weekly total pain burden across weeks 1–3 was compared between galcanezumab and placebo. To explore construct validity, mean weekly total pain burden scores were stratified by Patient Global Impression of Improvement (PGI-I) responses at the week 4 clinic visit. Results The reduction from baseline in mean weekly total pain burden was significantly greater with galcanezumab (N=49) than with placebo (N=57): the least squares mean difference was −11.18 severity-weighted hours (p=0.035). Median weekly total pain burden decreased as PGI-I ratings improved, from 33.6 to 5.0 severity-weighted hours for patients who felt “very much worse” and “very much better,” respectively. Conclusion Galcanezumab significantly reduced mean weekly total pain burden compared with placebo in patients with episodic cluster headache. The composite pain measure demonstrated construct validity. Total pain burden may provide a holistic measure of the pain of episodic cluster headache. Clinical Trials ClinicalTrials.gov, NCT02397473.
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Affiliation(s)
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | | | - Tina Oakes
- Eli Lilly and Company, Indianapolis, IN, USA
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25
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Pohl H, Gantenbein AR, Sandor PS, Schoenen J, Andrée C. The impact of the disease burden on the quality of life of cluster headache patients. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211029909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Cluster headache cannot be cured, and not all attacks can be aborted or prevented. Nevertheless, therapeutic guidelines focus solely on the attacks and ignore reverberations of the disorder on patients’ lives. However, it is likely that not only pain reduces patients’ quality of life (QoL). Objective: To investigate whether the interictal burden independently influence the QoL of subjects suffering from cluster headache. Methods: In this cross-sectional study, we asked patients with a self-reported cluster headache diagnosis to answer a modified EUROLIGHT questionnaire that included the EURO-HIS QoL scale. We built a generalised linear model and included the QoL as the dependent variable. Independent variables comprised both the ictal and the interictal burden. Results: The data of 625 participants entered the analysis. Several aspects of the interictal burden independently reduced the QoL. Among them were fear of pain, self-concealment, and private life difficulties due to the disorder. Conclusion: Both the ictal and the interictal burden of cluster headache independently reduce patients’ QoL. We advocate adopting a more holistic approach to cluster headache management extending the focus towards the afflicted person and their QoL, which would generate novel therapeutic goals and strategies, complementary to treating and preventing cluster headache attacks.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology & Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology & Neurorehabilitation, ZURZACH Care, Bad Zurzach, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, Citadelle Hospital, University of Liège, Liège, Belgium
| | - Colette Andrée
- Migraine Action, Bottmingen, Switzerland
- Department of Pharmaceutical Sciences, University Basel, Basel, Switzerland
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26
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Abstract
Background Cluster headache is a highly disabling primary headache disorder which is widely described as the most painful condition a human can experience. Aim To provide an overview of the clinical characteristics, epidemiology, risk factors, differential diagnosis, pathophysiology and treatment options of cluster headache, with a focus on recent developments in the field. Methods Structured review of the literature on cluster headache. Results Cluster headache affects approximately one in 1000 of the population. It is characterised by attacks of severe unilateral head pain associated with ipsilateral cranial autonomic symptoms, and the tendency for attacks to occur with circadian and circannual periodicity. The pathophysiology of cluster headache and other primary headache disorders has recently become better understood and is thought to involve the hypothalamus and trigeminovascular system. There is good quality evidence for acute treatment of attacks with parenteral triptans and high flow oxygen; preventive treatment with verapamil; and transitional treatment with oral corticosteroids or greater occipital nerve injection. New pharmacological and neuromodulation therapies have recently been developed. Conclusion Cluster headache causes distinctive symptoms, which once they are recognised can usually be managed with a variety of established treatments. Recent pathophysiological understanding has led to the development of newer pharmacological and neuromodulation therapies, which may soon become established in clinical practice.
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Affiliation(s)
- Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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27
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Mavridis T, Breza M, Deligianni C, Mitsikostas DD. Current advances in the management of cluster headaches. Expert Opin Pharmacother 2021; 22:1931-1943. [PMID: 33989098 DOI: 10.1080/14656566.2021.1924148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cluster headache (CH) is probably the most severe idiopathic pain condition, yet its current medical management remains poor.Areas covered: Only repurpose medicines are currently in use for the prevention of CH, partially because the pathophysiology of the condition is still elusive. In this article we performed a systematic review to evaluate the evidence for efficacy of the currently available or emerging treatments for CH.Expert opinion: We found several ongoing randomized clinical trials testing prophylactic treatments for CH and only few for the standard ones. Recent data from randomized trials with monoclonal antibodies targeting the calcitonin gene related peptide pathway (anti-CGRP mAbs) are controversial, although its role in the pathogenesis of the condition is well documented. This inconsistency may depict inadequacies in clinical trial designing. Anti-CGRP mAbs and antagonists of pituitary adenylate cyclase-activating polypeptide (PACAP) along with neuromodulation techniques, are curing the necessary valuable evidence that could illuminate the therapeutical future for cluster headache. Orexin pathway is another attractive target for CH treatment. To improve the evidence for efficacy, we further propose that the design of the clinical trials for CH needs to be radically reviewed to allow more patients to participate.
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Affiliation(s)
- Theodoros Mavridis
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimos D Mitsikostas
- 1 Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Abstract
PURPOSE OF REVIEW The treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents. RECENT FINDINGS Galcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain. Cluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral autonomic symptoms. Attacks have a circadian and, often, seasonal pattern with periods of remission that can last months to years in episodic patients. Though a rare disease, an increasing number of studies have revealed novel targets for treatment. Treatment in cluster headache should focus on early intervention to reduce frequency of attacks and the length of the cycle, which improves outcomes and disability. Acute therapy is used to treat attacks, while bridging and preventive therapies are combined to reduce cycle length. Case 1: A 43-year-old man presents with the chief complaint of severe headaches. Upon general examination, he seems uncomfortable, agitated, and exhausted. He states that he hasn't "slept in over a week because of debilitating headaches." His headaches start around the same time every night: when he lays down to go to sleep. The pain is described as sharp, like a "hot poker" to his left eye. His partner has noticed that his eye droops and turns red when the pain starts. The attacks come on abruptly and prevent him from sleeping. The severe pain lasts 30 to 45 min, but he has mild-to-moderate pain that lingers for the rest of the night. He has seen his primary care physician, an allergist, and an ear, nose, and throat (ENT) specialist before coming to see a neurologist. Similar headaches occurred last year during the month of October as well. On further questioning, he reports that these headache attacks have been occurring almost yearly for the past 7 years. Each year, these headaches come on as the weather is changing and occur on a nightly basis for about 3 to 4 weeks.
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29
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Cluster headache pathophysiology - insights from current and emerging treatments. Nat Rev Neurol 2021; 17:308-324. [PMID: 33782592 DOI: 10.1038/s41582-021-00477-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 02/01/2023]
Abstract
Cluster headache is a debilitating primary headache disorder that affects approximately 0.1% of the population worldwide. Cluster headache attacks involve severe unilateral pain in the trigeminal distribution together with ipsilateral cranial autonomic features and a sense of agitation. Acute treatments are available and are effective in just over half of the patients. Until recently, preventive medications were borrowed from non-headache indications, so management of cluster headache is challenging. However, as our understanding of cluster headache pathophysiology has evolved on the basis of key bench and neuroimaging studies, crucial neuropeptides and brain structures have been identified as emerging treatment targets. In this Review, we provide an overview of what is known about the pathophysiology of cluster headache and discuss the existing treatment options and their mechanisms of action. Existing acute treatments include triptans and high-flow oxygen, interim treatment options include corticosteroids in oral form or for greater occipital nerve block, and preventive treatments include verapamil, lithium, melatonin and topiramate. We also consider emerging treatment options, including calcitonin gene-related peptide antibodies, non-invasive vagus nerve stimulation, sphenopalatine ganglion stimulation and somatostatin receptor agonists, discuss how evidence from trials of these emerging treatments provides insights into the pathophysiology of cluster headache and highlight areas for future research.
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30
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A retrospective observation on 105 patients with chronic cluster headache receiving indomethacin. Neurol Sci 2021; 42:4175-4182. [PMID: 33547540 DOI: 10.1007/s10072-021-05114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Indomethacin (IMC) as a prophylactic treatment is considered to be ineffective in cluster headache (CH). However, small series suggested the interest of IMC in CH. Some authors support that an IMC test is useful in all trigeminal autonomic cephalalgias. We described clinical features of IMC responders in a retrospective cohort of chronic cluster headache (CCH). METHODS This single-center and retrospective study was conducted in a tertiary care specialist headache center in France. Patients were selected between January 2007 and December 2008. We included all patients fulfilling CCH criteria (ICHD-3-beta). Data were collected from medical records. We recorded all the prescriptions of IMC as a prophylactic treatment. Responders were defined by 50% reduction in attack frequency; complete response was defined by disappearance of the attacks. The non-responders must have received at least 100 mg daily during 7 days. RESULTS The study consisted of 324 CCH, 121 female (37%) and 203 males (63%) with an average age at onset of 33.93 (± 14.71) years. Of the patients, 105 were treated with IMC. Thirty patients (29%) were responders. Thirty-four patients (32%) were non-responders. Responding status was undefined for 41 patients (39%). Twelve patients (11%) had a complete response. Responders were composed by 18 women (60%) and 12 men (40%) and had on average 44.89 (± 12.88) years. The minimal effective dose was 86.11 mg daily (± 48.72). DISCUSSION This study shows the interest of IMC in CCH patients. We recommend an IMC test as a third-line treatment in CCH.
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Schindler EAD, Cooper V, Quine DB, Fenton BT, Wright DA, Weil MJ, Sico JJ. "You will eat shoe polish if you think it would help"-Familiar and lesser-known themes identified from mixed-methods analysis of a cluster headache survey. Headache 2021; 61:318-328. [PMID: 33502769 DOI: 10.1111/head.14063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To characterize patient-reported ideas and concerns about cluster headache, treatment options, and management strategies. BACKGROUND Cluster headache patients experience severe pain and often suffer additional consequences from their disease. Patients have identified methods to cope with and combat cluster headache that are not widely known. METHODS Secondary analysis was performed using deidentified data from the online Clusterbusters Medication Use survey, wherein 10 questions allowed for freely written comments. Using mixed-methods techniques, neurologists with expertise in headache medicine identified themes from these comments. Subgroup analysis sought to identify variables associated with specific themes. RESULTS Among 2274 free-text responses from 493 adult participants, 23 themes were identified. Themes commonly discussed in the literature included such topics as "nothing worked" (24.7%, 122/493), "side effects" (12.8%, 63/493), and difficulties with "access/cost" (2.4%, 12/493). Less widely recognized themes included the use of "illicit substances" (35.5%, 175/493) and "vitamins/supplements" (12.2%, 60/493) in disease management. Lesser-known themes included "coffee" (5.3%, 26/493) and "exercise/physical activity" (4.7%, 23/493). Using strict significance criteria, no subgroup was associated with any theme. Several poignant quotes highlighted patient thoughts and experiences. CONCLUSIONS This mixed-methods analysis identified challenges endured by cluster headache patients, as well as a variety of patient-directed disease management approaches. The volunteered information spotlights pharmacological, physiological, and psychological aspects of cluster headache that warrant further exploratory and interventional investigation.
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Affiliation(s)
- Emmanuelle A D Schindler
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Vanessa Cooper
- Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Douglas B Quine
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Brenda T Fenton
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Jason J Sico
- Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Pedersen AS, Snoer A, Barloese M, Petersen A, Jensen RH. Prevalence of pre-cluster symptoms in episodic cluster headache: Is it possible to predict an upcoming bout? Cephalalgia 2021; 41:799-809. [PMID: 33472428 DOI: 10.1177/0333102421989255] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Early symptoms prior to a cluster headache bout have been reported to occur days or weeks before the actual beginning of the cluster headache bouts. This study aimed to describe the prevalence of pre-cluster (premonitory) symptoms and examine the predictability of an upcoming cluster headache bout. METHODS 100 patients with episodic cluster headache were included in this retrospective cross-sectional study. All patients underwent a semi-structured interview including 25 questions concerning pre-cluster symptoms. RESULTS Pre-cluster symptoms were reported by 86% of patients with a mean of 6.8 days (interquartile range 3-14) preceding the bout. An ability to predict an upcoming bout was reported by 57% with a mean 4.6 days (interquartile range 2-7) before the bout. Occurrence of shadow attacks was associated with increased predictability (odds ratio: 3.06, confidence interval: 1.19-7.88, p-value = 0.020). In remission periods, 58% of patients reported mild cluster headache symptoms and 53% reported occurrence of single shadow attacks. CONCLUSIONS The majority of episodic cluster headache patients experienced pre-cluster symptoms, and more than half could predict an upcoming bout, suggesting the significant potential of early intervention. Furthermore, the experience of mild cluster headache symptoms and infrequent shadow attacks in remission periods is common and suggest an underlying pathophysiology extending beyond the cluster headache bouts.
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Affiliation(s)
- Adam Sebastian Pedersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Agneta Snoer
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mads Barloese
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anja Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
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Obermann M, Nägel S, Ose C, Sonuc N, Scherag A, Storch P, Gaul C, Böger A, Kraya T, Jansen JP, Straube A, Freilinger T, Kaube H, Jürgens TP, Diener HC, Katsarava Z, Kleinschnitz C, Holle D. Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol 2021; 20:29-37. [DOI: 10.1016/s1474-4422(20)30363-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]
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Courault P, Demarquay G, Zimmer L, Lancelot S. Cluster headache: state of the art of pharmacological treatments and therapeutic perspectives. Fundam Clin Pharmacol 2020; 35:595-619. [DOI: 10.1111/fcp.12636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Pierre Courault
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
| | | | - Luc Zimmer
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
- National Institute for Nuclear Science and Technology (INSTN) CEA Saclay France
| | - Sophie Lancelot
- Lyon Neuroscience Research Center (CRNL) Université de LyonCNRSINSERM Lyon France
- Hospices Civils de Lyon (HCL) Lyon France
- CERMEP‐Imaging Platform Groupement Hospitalier Est Bron France
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35
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Petersen AS, Lund N, Jensen RH, Barloese M. Real-life treatment of cluster headache in a tertiary headache center - results from the Danish Cluster Headache Survey. Cephalalgia 2020; 41:525-534. [PMID: 33203216 DOI: 10.1177/0333102420970455] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pharmacological treatment of cluster headache constitutes the core of clinical management, but evidence is sparse. We aimed to generate insight in the existing treatment and identify associations between clinical features and treatment response. METHODS Patients aged 18-65 diagnosed with cluster headache according to the ICHD-2 completed a questionnaire followed by a structured interview. Multiple logistic regression was used to identify associations. RESULTS The population consisted of 400 patients with an episodic: chronic ratio of 1.7:1. Episodic patients were more likely to respond to triptans (odds ratio = 1.77, confidence interval: 1.08-2.91, p = 0.023) and oxygen (odds ratio = 1.64, confidence interval: 1.05-2.57, p = 0.031) than chronic. Oxygen response was less likely if pain intensity was very severe (odds ratio = 0.53, confidence interval: 0.33-2.57, p = 0.006) and the risk of a poor response increased with disease duration (odds ratio = 0.79, confidence interval: 0.65-0.96, p = 0.016). Among current users of sumatriptan injection and oxygen, the proportion achieving 100% relief was higher with sumatriptan injection (p > 0.001) than with oxygen. No associations were identified regarding verapamil. Only 57% of current users of preventive medication responded at a 50% level. CONCLUSION Episodic cluster headache is more responsive to acute therapy than chronic. Further, sumatriptan injection was more effective than oxygen and the responder-rate was limited with verapamil. More effective acute and preventive therapies are needed for cluster headache patients.
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Affiliation(s)
- Anja Sofie Petersen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Nunu Lund
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mads Barloese
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark.,Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Kikui S, Sugiyama H, Danno D, Kashiwaya Y, Takeshima T. Chronic Cluster Headache with a Pediatric Onset: The First Japanese Case Report. Intern Med 2020; 59:2937-2940. [PMID: 32727988 PMCID: PMC7725624 DOI: 10.2169/internalmedicine.5207-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 9-year-old female reported left-sided, excruciatingly severe, stabbing orbital pain with cranial autonomic symptoms. The attacks continued for 1 year with a remission period of 2 months. Each attack duration was approximately 120 minutes with a frequency of two to three times a day. The patient was diagnosed with chronic cluster headache (CCH) according to the third edition of the International Classification of Headache Disorders. A combination of low-dose verapamil and lomerizine once a week decreased the frequency of the attacks, and oral sumatriptan became an effective abortive therapy. No case reports of pediatric CCH have been previously published in Japan.
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Affiliation(s)
- Shoji Kikui
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Hanako Sugiyama
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | - Daisuke Danno
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Japan
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Kudrow D, Andrews JS, Rettiganti M, Oakes T, Bardos J, Gaul C, Riesenberg R, Wenzel R, Kuruppu D, Martinez J. Treatment Outcomes in Patients Treated With Galcanezumab vs Placebo: Post Hoc Analyses From a Phase 3 Randomized Study in Patients With Episodic Cluster Headache. Headache 2020; 60:2254-2264. [PMID: 33179263 PMCID: PMC7756634 DOI: 10.1111/head.14011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
Background Cluster headache (CH) is a highly disabling primary headache disorder. To date, characterization of outcomes in the preventive treatment of episodic CH, including precise definitions of clinically meaningful attack frequency reduction and impact on acute treatment management, is lacking. Methods This was a Phase 3, randomized, double‐blind, placebo‐controlled study in patients (men or women aged 18‐65 years) diagnosed with episodic CH as defined by the International Classification of Headache Disorders‐3 beta criteria. In this post hoc analysis, we evaluated the median time‐to‐first occurrence of ≥50, ≥75, or 100% reduction from baseline in CH attack frequency, and impact on acute medication use. An anchor‐based assessment of clinically relevant attack frequency reduction using the Patient Global Impression of Improvement (PGI‐I) scores at Week 4 was also assessed. Results The median time‐to‐first occurrence of ≥50, ≥75, or 100% reduction from baseline in CH attacks was consistently shorter (9‐10 days sooner) with galcanezumab vs placebo (median [95% confidence interval, 95% CI]: ≥50%, 5 days [4.0 to 7.0] vs 14 days [6.0 to 19.0]; ≥75%, 11 days [7.0 to 16.0] vs 21 days [13.0 to 26.0]; 100%, 22 days [16.0 to 37.0] vs 32 days [23.0 to 34.0]). Mean reduction from baseline in the overall frequency of weekly pooled acute medication use across Weeks 1‐3 was significantly greater with galcanezumab vs placebo (11.0 vs 5.5; odds ratio, OR [95% CI]: 5.52 [1.02, 10.01]; P value = .017). Patients reporting “much better” on the PGI‐I experienced a median weekly CH attack reduction of approximately 43% from baseline across Weeks 1‐3. The overall odds of achieving an attack reduction threshold of 43% across Weeks 1‐3 was significantly higher with galcanezumab vs placebo (Weeks 1‐3: OR [95% CI], 2.60 [1.3 to 5.3]). Conclusions Faster median time‐to‐first occurrence of response rates, lower frequency of pooled acute medications use, and a greater proportion of patients achieving a response anchored by patient‐reported improvement were observed for galcanezumab vs placebo.
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Affiliation(s)
- David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | | | | | - Tina Oakes
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Charly Gaul
- Migraine and Headache Clinic, Koenigstein, Germany
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Primaries non-migraine headaches treatment: a review. Neurol Sci 2020; 41:385-394. [PMID: 33021705 DOI: 10.1007/s10072-020-04762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the "headache world," great attention has always been paid to migraine patients, especially for the research and development of new therapies. For the other forms of primary headaches, especially those of Chapters 2 and 3 of the classification, there are however therapies that, even if not specific, can give significant results. Tension-type headache recognizes in NSAIDs the most effective drugs to treat acute attack, while prevention is based on the use of tricyclic antidepressants and muscle relaxants. For TACs, the discussion is more complex: first of all, there are two forms of primary headache that respond absolutely to indomethacin. For these, the main problem is how to manage the possible side effects arising from prolonged treatments and possibly what to use as an alternative. For cluster headaches and short-lasting unilateral neuralgiform headache attacks, we have drugs with good efficacy as regards medical therapy, such as verapamil or lamotrigine, but in recent years, neuromodulation techniques, both surgical and non-invasive, have also been affirming themselves, which represent a more possibility for forms of headache that are often very disabling and resistant to common analgesics.
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Mecklenburg J, Sanchez Del Rio M, Reuter U. Cluster headache therapies: pharmacology and mode of action. Expert Rev Clin Pharmacol 2020; 13:641-654. [DOI: 10.1080/17512433.2020.1774361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jasper Mecklenburg
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Abstract
Cluster headache is characterised by attacks of excruciating unilateral headache or facial pain lasting 15 min to 3 h and is seen as one of the most intense forms of pain. Cluster headache attacks are accompanied by ipsilateral autonomic symptoms such as ptosis, miosis, redness or flushing of the face, nasal congestion, rhinorrhoea, peri-orbital swelling and/or restlessness or agitation. Cluster headache treatment entails fast-acting abortive treatment, transitional treatment and preventive treatment. The primary goal of prophylactic and transitional treatment is to achieve attack freedom, although this is not always possible. Subcutaneous sumatriptan and high-flow oxygen are the most proven abortive treatments for cluster headache attacks, but other treatment options such as intranasal triptans may be effective. Verapamil and lithium are the preventive drugs of first choice and the most widely used in first-line preventive treatment. Given its possible cardiac side effects, electrocardiogram (ECG) is recommended before treating with verapamil. Liver and kidney functioning should be evaluated before and during treatment with lithium. If verapamil and lithium are ineffective, contraindicated or discontinued because of side effects, the second choice is topiramate. If all these drugs fail, other options with lower levels of evidence are available (e.g. melatonin, clomiphene, dihydroergotamine, pizotifen). However, since the evidence level is low, we also recommend considering one of several neuromodulatory options in patients with refractory chronic cluster headache. A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown. Since effective preventive treatment can take several weeks to titrate, transitional treatment can be of great importance in the treatment of cluster headache. At present, greater occipital nerve injection is the most proven transitional treatment. Other options are high-dose prednisone or frovatriptan.
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Wei DY, Khalil M, Goadsby PJ. Managing cluster headache. Pract Neurol 2019; 19:521-528. [PMID: 31278205 PMCID: PMC6902063 DOI: 10.1136/practneurol-2018-002124] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/10/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022]
Abstract
Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Cluster headache attacks often occur more than once a day, and typically manifesting in bouts. It has a point prevalence of 1 in 1000 and is the most common trigeminal autonomic cephalalgia. This article aims to guide general neurologists to an accurate diagnosis and practical management options for cluster headache patients.
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Affiliation(s)
- Diana Y Wei
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Modar Khalil
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- Department of Neurology, Hull Royal Infirmary, Hull, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, UK
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Gelfand AA, Goadsby PJ. Cluster Headache and Calcitonin Gene-Related Peptide-More on Quantum Therapeutics in Headache Medicine. JAMA Neurol 2019; 75:1179-1180. [PMID: 29987331 DOI: 10.1001/jamaneurol.2018.1428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Amy A Gelfand
- Department of Neurology, University of California, San Francisco, San Francisco.,Section Editor
| | - Peter J Goadsby
- Department of Neurology, University of California, San Francisco, San Francisco.,National Institute for Health Research-Wellcome Trust, King's Clinical Research Facility, King's College London, London, United Kingdom
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Petersen AS, Barloese MCJ, Snoer A, Soerensen AMS, Jensen RH. Verapamil and Cluster Headache: Still a Mystery. A Narrative Review of Efficacy, Mechanisms and Perspectives. Headache 2019; 59:1198-1211. [DOI: 10.1111/head.13603] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Anja S. Petersen
- Department of Neurology, Danish Headache Center Rigshospitalet‐Glostrup Glostrup Denmark
| | - Mads C. J. Barloese
- Department of Neurology, Danish Headache Center Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging Hvidovre Hospital Hvidovre Denmark
| | - Agneta Snoer
- Department of Neurology, Danish Headache Center Rigshospitalet‐Glostrup Glostrup Denmark
| | - Anne Mette S. Soerensen
- Department of Clinical Pharmacology Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - Rigmor H. Jensen
- Department of Neurology, Danish Headache Center Rigshospitalet‐Glostrup Glostrup Denmark
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Goadsby PJ, Dodick DW, Leone M, Bardos JN, Oakes TM, Millen BA, Zhou C, Dowsett SA, Aurora SK, Ahn AH, Yang JY, Conley RR, Martinez JM. Trial of Galcanezumab in Prevention of Episodic Cluster Headache. N Engl J Med 2019; 381:132-141. [PMID: 31291515 DOI: 10.1056/nejmoa1813440] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Episodic cluster headache is a disabling neurologic disorder that is characterized by daily headache attacks that occur over periods of weeks or months. Galcanezumab, a humanized monoclonal antibody to calcitonin gene-related peptide, may be a preventive treatment for cluster headache. METHODS We enrolled patients who had at least one attack every other day, at least four total attacks, and no more than eight attacks per day during a baseline assessment, as well as a history of cluster headache periods lasting at least 6 weeks, and randomly assigned them to receive galcanezumab (at a dose of 300 mg) or placebo, administered subcutaneously at baseline and at 1 month. The primary end point was the mean change from baseline in the weekly frequency of cluster headache attacks across weeks 1 through 3 after receipt of the first dose. The key secondary end point was the percentage of patients who had a reduction from baseline of at least 50% in the weekly frequency of cluster headache attacks at week 3. Safety was also assessed. RESULTS Recruitment was halted before the trial reached the planned sample size of 162 because too few volunteers met the eligibility criteria. Of 106 enrolled patients, 49 were randomly assigned to receive galcanezumab and 57 to receive placebo. The mean (±SD) number of cluster headache attacks per week in the baseline period was 17.8±10.1 in the galcanezumab group and 17.3±10.1 in the placebo group. The mean reduction in the weekly frequency of cluster headache attacks across weeks 1 through 3 was 8.7 attacks in the galcanezumab group, as compared with 5.2 in the placebo group (difference, 3.5 attacks per week; 95% confidence interval, 0.2 to 6.7; P = 0.04). The percentage of patients who had a reduction of at least 50% in headache frequency at week 3 was 71% in the galcanezumab group and 53% in the placebo group. There were no substantial between-group differences in the incidence of adverse events, except that 8% of the patients in the galcanezumab group had injection-site pain. CONCLUSIONS Galcanezumab administered subcutaneously at a dose of 300 mg once monthly reduced the weekly frequency of attacks of episodic cluster headache across weeks 1 through 3 after the initial injection, as compared with placebo. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT02397473.).
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Affiliation(s)
- Peter J Goadsby
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - David W Dodick
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Massimo Leone
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Jennifer N Bardos
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Tina M Oakes
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Brian A Millen
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Chunmei Zhou
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Sherie A Dowsett
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Sheena K Aurora
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Andrew H Ahn
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Jyun-Yan Yang
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - Robert R Conley
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
| | - James M Martinez
- From the NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, and King's College Hospital, London (P.J.G.); the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.W.D.); the IRCCS Foundation Carlo Besta Neurologic Institute, Milan (M.L.); Eli Lilly, Indianapolis (J.N.B., T.M.O., B.A.M., C.Z., S.A.D., S.K.A., A.H.A., J.-Y.Y., R.R.C., J.M.M.); and the University of Maryland School of Medicine, Baltimore (R.R.C.)
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Kaye AD, Motejunas MW, Cornett EM, Ehrhardt KP, Novitch MB, Class J, Siddaiah H, Hart BM, Urman RD. Emerging Novel Pharmacological Non-opioid Therapies in Headache Management: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:53. [PMID: 31286276 DOI: 10.1007/s11916-019-0808-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Chronic headache is a significant worldwide problem despite advances in treatment options. Chronic headaches can have significant a detrimental impact on the activities of daily living. RECENT FINDINGS Patients who do not obtain relief from chronic head and neck pain from conservative treatments are commonly being managed with interventional treatments. These interventional treatment options include botulinum toxin A, injections, local occipital nerve anesthetic and corticosteroid infiltration, occipital nerve subcutaneous stimulation and occipital nerve pulsed radiofrequency (PRF), sphenopalatine ganglion block, and radiofrequency techniques. Recently, evidence has emerged to support non-opioid-based drug and interventional approaches. Overall, more research is necessary to clarify the safety and efficacy of interventional treatments and to better understand the pathogenesis of chronic headache pain.
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Affiliation(s)
- Alan David Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Mark W Motejunas
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Ken P Ehrhardt
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave, New Orleans, LA, 70112, USA
| | - Matthew B Novitch
- University of Washington Anesthesiology, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Joshua Class
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Harish Siddaiah
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Brendon M Hart
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Moon HS, Cho SJ, Kim BK, Lee MJ, Chung PW, Sohn JH, Kim SK, Choi YJ, Song TJ, Kim JM, Park JW, Park KY, Chung JM, Ahn JY, Kim BS, Oh K, Lee KS, Chung CS, Chu MK. Field testing the diagnostic criteria of cluster headache in the third edition of the International Classification of Headache Disorders: A cross-sectional multicentre study. Cephalalgia 2019; 39:900-907. [DOI: 10.1177/0333102419837159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background *These authors are shared first authors. The recently published third edition of the International Classification of Headache Disorders (ICHD-3) revised the criteria for accompanying symptoms of cluster headache (CH) and the remission period of chronic cluster headache (CCH). This study aimed at testing the validity of the ICHD-3 criteria for CH by using data from the Korean Cluster Headache Registry. Methods Consecutive patients with CH and probable cluster headache (PCH) were prospectively recruited from 15 hospitals. We analysed the validity of the revised ICHD-3 criteria for CH against the beta version of the third edition of the ICHD (ICHD-3β). Results In total, 193 patients were enrolled: 140 (72.5%), 5 (2.6%) and 22 (11.4%) had episodic cluster headache (ECH), CCH, and PCH, respectively. The remaining 26 (13.5%) had CH with undetermined remission periods. One patient with ECH and one with PCH had only forehead and facial flushing and were diagnosed with PCH and non-cluster headache, respectively, according to the ICHD-3. Four participants with ECH according to the ICHD-3β had remission periods of > 1 month and between 1 and 3 months and were newly diagnosed with CCH according to the ICHD-3. Conclusion The change from ICHD-3β to ICHD-3 resulted in few differences in the diagnoses of CH and PCH.
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Affiliation(s)
- Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yun-Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Myun Chung
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
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Abstract
A large series of different ion channels have been identified and investigated as potential targets for new medicines for the treatment of a variety of human diseases, including pain. Among these channels, the voltage gated calcium channels (VGCC) are inhibited by drugs for the treatment of migraine, neuropathic pain or intractable pain. Transient receptor potential (TRP) channels are emerging as important pain transducers as they sense low pH media or oxidative stress and other mediators and are abundantly found at sites of inflammation or tissue injury. Low pH may also activate acid sensing ion channels (ASIC) and mechanical forces stimulate the PIEZO channels. While potent agonists of TRP channels due to their desensitizing action on pain transmission are used as topical applications, the potential of TRP antagonists as pain therapeutics remains an exciting field of investigation. The study of ASIC or PIEZO channels in pain signaling is in an early stage, whereas antagonism of the purinergic P2X3 channels has been reported to provide beneficial effects in chronic intractable cough. The present chapter covers these intriguing channels in great detail, highlighting their diverse mechanisms and broad potential for therapeutic utility.
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Affiliation(s)
- Francesco De Logu
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy.
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48
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Vollesen AL, Benemei S, Cortese F, Labastida-Ramírez A, Marchese F, Pellesi L, Romoli M, Ashina M, Lampl C. Migraine and cluster headache - the common link. J Headache Pain 2018; 19:89. [PMID: 30242519 PMCID: PMC6755613 DOI: 10.1186/s10194-018-0909-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/20/2018] [Indexed: 01/07/2023] Open
Abstract
Although clinically distinguishable, migraine and cluster headache share prominent features such as unilateral pain, common pharmacological triggers such glyceryl trinitrate, histamine, calcitonin gene-related peptide (CGRP) and response to triptans and neuromodulation. Recent data also suggest efficacy of anti CGRP monoclonal antibodies in both migraine and cluster headache. While exact mechanisms behind both disorders remain to be fully understood, the trigeminovascular system represents one possible common pathophysiological pathway and network of both disorders. Here, we review past and current literature shedding light on similarities and differences in phenotype, heritability, pathophysiology, imaging findings and treatment options of migraine and cluster headache. A continued focus on their shared pathophysiological pathways may be important in paving future treatment avenues that could benefit both migraine and cluster headache patients.
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Affiliation(s)
- Anne Luise Vollesen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Benemei
- Health Sciences Department, University of Florence and Headache Centre, Careggi University Hospital, Florence, Italy
| | - Francesca Cortese
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Polo Pontino, Latina, Italy
| | - Alejandro Labastida-Ramírez
- Dep Internal Medicine, Division of Vascular Pharmacology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Lanfranco Pellesi
- Medical Toxicology, Headache and Drug Abuse Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Romoli
- Neurology Clinic, University of Perugia - S.M. Misericordiae Hospital, Perugia, Italy
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Lampl
- Department of Neurogeriatric Medicine, Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010, Linz, Austria.
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49
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Stringer JA, Calvert S, Sinclair A. Trigeminal autonomic cephalgia: A rare cause of headache in children. J Paediatr Child Health 2018; 54:918-921. [PMID: 29655264 DOI: 10.1111/jpc.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Josephine A Stringer
- Department of Neurosciences, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Sophie Calvert
- Department of Neurosciences, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Adriane Sinclair
- Department of Neurosciences, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
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50
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Abstract
Cluster headache (CH) is a debilitating primary headache disorder. Although uncommon, affecting only 0.1% of population, it is one of the most painful conditions known to humankind. Three strategies are employed for effective treatment of CH, namely, abortive therapy, transitional therapy, and preventive therapy. Being an uncommon condition, there is a paucity of large-scale controlled trials and evidence of various therapies are based on smaller studies. This review primarily focuses on therapies with highest quality of evidence and also on the emerging therapies for CH.
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Affiliation(s)
- William S. Kingston
- Centre for Headache, Women's College Hospital, University of Toronto, Toronto, ON, USA
| | - David W. Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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