Abstract
BackgroundCluster headache (CH) is a clinically well-defined primary headache disorder, approximately 20% of cluster headache sufferers experience recurrent attacks without periods of significant remission. For the treatment of chronic cluster headache (CCH) only limited therapeutic options are available.MethodsA potential refractory CCH patient group was identified according to the clinical definition of rCCH based on the consensus statement of the European Headache Federation (EHF). Treatment with OnabotulinumtoxinA (BoNT-A; Botox®, 150 Allergan IU) was done according to the PREEMPT study protocol. A standardized headache diary was used for recording frequency, duration of attacks and pain intensity. To assess personal burden the HIT-6 and the Hospital Anxiety and Depression scale was used. Primary outcome measure was a > 50% reduction in headache minutes.ResultsSeventeen male patients suffering from rCCH, aged 32 ± 11 (mean ± SD) years, presenting a mean disease duration of 6.6 years completed the study of 28 weeks. The cut-off point of > 50% reduction in headache minutes as positive result was reached in 58.8%, 29.4% experienced an improvement of 30–50%. Mean frequency of headache days dropped from 28.2 to 11.8 days at week 24 (p = 0.0001; 95% CI -21.33 to − 11.61;). Intensity of remaining attacks was also reduced significantly. Headache disability scores showed a trend to improvement after BoNT-A.ConclusionsEncouraging results for the treatment with BoNT-A in rCCH patients were observed in our study population.
Highlights
Cluster headache (CH) is a clinically well-defined primary headache disorder, approximately 20% of cluster headache sufferers experience recurrent attacks without periods of significant remission
Seventeen male patients suffering from refractory CCH (rCCH), aged 32 ± 11 years, presenting a mean disease duration of 6.6 years completed the study of 28 weeks
The cut-off point of > 50% reduction in headache minutes as positive result was reached in 58.8%, 29.4% experienced an improvement of 30–50%
Summary
Cluster headache (CH) is a clinically well-defined primary headache disorder, approximately 20% of cluster headache sufferers experience recurrent attacks without periods of significant remission. For the treatment of chronic cluster headache (CCH) only limited therapeutic options are available. Cluster headache (CH) is a clinically well-defined primary headache disorder occurring in both episodic and chronic forms. Chronic cluster headache (CCH) is a rare condition - approximately 20% of cluster headache sufferers experience recurrent attacks without periods of significant remission [1]. The evolution to CCH has been reported to occur in 3.8% to 12.9% of episodic CH sufferers [3]. According to the IHS classification ICHD-3rd version [4] CCH fulfils criteria for episodic cluster headache with attacks recurring without a remission period or with remissions lasting < 3 month for at least one year.
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