Prophylactic Treatment Of Cluster Headache Research Articles

Naratriptan in the prophylactic treatment of cluster headache - a multicenter cooperative study -

Background: Few therapies are effective for preventing cluster headache. Naratriptan, a 5-hydroxytryptamine1B/D (5-HT1B/D)-agonist, appears effective as a pharmacotherapy for migraine. There have been few reports whether naratriptan could reduce the frequency of cluster headache attacks.

Non-invasive Neuromodulation in Primary Headaches.

There is growing interest in neuromodulation for primary headache conditions. Invasive modalities such as occipital nerve stimulation, deep brain stimulation and sphenopalatine ganglion stimulation are reserved for the most severe and intractable patients. Non-invasive options such as vagal nerve stimulation (nVNS), supraorbital nerve stimulation (nSONS) and transcranial magnetic nerve stimulation (TMS) have all emerged as potentially useful headache treatments. This review examines the evidence base for non-invasive neuromodulation in trigeminal autonomic cephalalgias and migraine. Although a number of open-label series of non-invasive neuromodulation devices have been published, there is very little controlled evidence for their use in any headache condition. Open-label evidence suggests that nVNS may have a role in the prophylactic treatment of cluster headache and there is limited evidence to suggest it may be useful in the acute treatment of cluster and potentially migraine attacks. There is limited controlled evidence to suggest a role for nSONS in the prophylactic treatment of episodic migraine but there is no evidence to support its use in cluster headache. TMS may be efficacious in the acute treatment of episodic migraine has no controlled evidence to support its use as a preventative in any headache condition. Non-invasive neuromodulation techniques are an attractive treatment option with excellent safety profiles but their use is not yet supported by high-quality randomised controlled trials.

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

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

High-dose intravenous methylprednisolone for the prophylactic treatment of cluster headache

BackgroundTriptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26–54 years) afflicted by frequent (often daily) CH attacks.FindingsTotal MP dose per infusion was 250–500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration.ConclusionsHigh-dose MP therapy reduced CH attack frequency and improved patient quality of life.

Frovatriptan for Prophylactic Treatment of Cluster Headache

Frovatriptan for Prophylactic Treatment of Cluster Headache

Frovatriptan for Prophylactic Treatment of Cluster Headache: Lessons for Future Trial Design

The aim of this study was to determine whether frovatriptan would show efficacy in short term prophylactic treatment of episodic cluster headache (ECH) in comparison to placebo. The 5-hydroxytryptamine(1B/d) (5-HT(1B/d) )-agonists naratriptan, eletriptan, and frovatriptan have been shown to reduce the frequency of ECH. So far, no double-blind placebo-controlled trials have investigated the potential prophylactic effects of 5-HT(1B/d) -agonists in ECH. The trial was conducted as a multi-center, placebo-controlled, randomized, double-blind, prospective phase III parallel-group trial with two independent treatment groups (5 mg frovatriptan vs placebo). It was planned to randomize about 96 patients (48 patients per group) into the trial to obtain 80 evaluable patients (40 patients per group). The study was prematurely discontinued after 13 months and enrollment of 11, instead of the planned 80 patients, by the sponsor due to infeasibility. Recruitment was slow and each of the patients included conducted major protocol violations. The differences in the primary and secondary endpoints were not significant. This study shows that particular therapeutic aims are impossible to be addressed in a double-blind, randomized, parallel group, study design with specific inclusion and exclusion criteria according to the International Headache Society (IHS) guidelines for controlled trials of drugs in cluster headache. Further studies are required to evaluate the potential efficacy of triptans in the prophylactic treatment of ECH. The outcome of the trial suggests that the recommendations of the Guidelines for controlled Trials of Drugs in Cluster Headache from the IHS should be revised.

Verapamil for Cluster Headache. Clinical Pharmacology and Possible Mode of Action

Verapamil is used mainly in cardiovascular diseases. High-dose verapamil (360-720 mg) is, however, currently the mainstay in the prophylactic treatment of cluster headache. The oral pharmacokinetics are variable. The pharmacodynamic effect of verapamil, the effect on blood pressure, also varies considerably among subjects. The dose of verapamil used for cluster headache is approximately double the dose used in cardiovascular disease, most likely because verapamil is a substrate for the efflux transporter P-glycoprotein in the blood-brain barrier. The access of verapamil to the central nervous system is therefore limited. The clinical use of verapamil in cluster headache is reviewed and several relevant drug interactions are mentioned. Finally, its possible mode of action in cluster headache is discussed. The effect of verapamil in cluster headache most likely takes place in the hypothalamus.Verapamil is an L-type calcium channel blocker but it is also a blocker of other calcium channels (T-, P-, and possibly N- and Q-type Ca(2+) channels) and the human ether-a-go-go-related gene potassium channel. With so many different actions of verapamil, it is impossible at the present time to single out a certain mode of action of the drug in cluster headache.

Traitement des céphalées trigémino-vasculaires : nouveautés et perspectives

Remarkable therapeutic improvements have come forward recently for trigemino-autonomic cephalalgias. Attack treatment in cluster headache is based on sumatriptan and oxygen. Non-vasoconstrictive treatments are opening a new post-triptan era but are not yet applicable. Prophylactic treatment of cluster headache is based on verapamil and lithium. The efficacy of anti-epileptic drugs in cluster headache remains to be demonstrated. Surgical treatment aimed at the parasympathetic pathways and at the trigeminal nerve demonstrates a high rate of recurrence and adverse events and questions about the relevance of a "peripheral" target in cluster headache. The efficacy of continuous hypothalamic stimulation in patients with intractable headache constitutes a breakthrough, but must be demonstrated at a larger scale and the benefice/risk ratio must be carefully evaluated. Indomethacin still remains the gold standard in paroxysmal hemicrania treatment. Until recently SUNCT was considered an intractable condition. However there are some reports of complete relief with lamotrigine, topiramate and gabapentin.

Diagnostic and therapeutic guidelines for migraine. Italian Society for the Study of Headaches (SISC)

The Italian Society for the Study of Headaches (SISC) published the first guidelines for diagnosis and treatment of migraine in 1993. In 2000, the Executive Committee of the SISC decided to provide updated diagnostic and therapeutic guidelines for migraine and cluster headache for headache experts and physicians dedicated to headaches. For this purpose an Ad Hoc Committee was formed, taking into consideration the multidisciplinary characteristics of the society, and was composed of prominent Italian researchers from various disciplines. The guidelines were published in 2001 and will be updated each year on the basis of new information concerning diagnostic and therapeutic strategies for migraine and cluster headache. The Ad Hoc Committee was organized into subcommittees, each responsible for a different topic: diagnosis of migraine; symptomatic treatment of migraine; prophylactic treatment of migraine; non–pharmacological treatment of migraine; diagnosis, symptomatic and prophylactic treatment of cluster headache; and lastly trigeminal autonomic cranial neuralgias (TACs) and unsolved questions. The present paper reports the major conclusions of the first three subcommittees only. From a methodological point of view, it was decided that all the information reported in the guidelines would be evidencebased. This involved a thorough research on Medline and Pubmed taking into consideration all the articles concerning clinical, laboratory and instrumental examinations and therapeutic approaches for migraine and cluster headache. As far as migraine is concerned, all studies available in the literature examining the sensitivity, specificity, predictive value of clinical history, neurological examination, laboratory tests and instrumental examination were evaluated to identify variables useful in the differential diagnosis of secondary headaches mimicking migraine attacks and to identify surrogate indicators of migraine. Four groups of recommendations, based on the levels of evidence, scientific effect and clinical assessment were defined for all symptomatic and prophylactic drugs. Information regarding clinical contraindications and pharmacological interactions for each class of symptomatic and prophylactic anti-migraine drugs were also reported.

Le traitement de l’algie vasculaire de la face

Introduction. – The cluster headache (CH) is one of the most severe types of head pain. It is a typical example of a periodic disease and the International Headache Society classification recognizes two forms of this disease: episodic and chronic CH. Its prevalence is about 0.1 to 0.4% in the general population. Current knowledge and key points. – Pathophysiology: A global hypothesis is still lacking to explain the pain, the vasodilation, the autonomic features (ipsilateral lacrimation, conjunctiva injection, rhinorrhea, partial Horner syndrome, etc.) and the periodicity of the CH. Pain and vasodilation seem secondary to an activation of the trigeminal vascular system and the periodicity of the attacks is thought to be due to a dysfunction of hypothalamic biologic clock mechanisms. Treatment of acute CH attacks: The most effective agents are oxygen inhalation and subcutaneous sumatriptan, a 5HT1B and D receptor agonist which has vasoconstrictor and anti-neurogenic inflammation properties by blocking the release from the trigeminal-sensitive fibers of neuropeptides such as CGRP and substance P. With subcutaneous sumatriptan, headache relief is very rapid, within 5 to 10 min. Prophylactic treatment of CH: The number of attacks per day varies from one to three, but some patients can have four to eight per day and acute treatments fail to provide sufficient relief or give rise to side-effects. Several different regimens have been proven effective. Future prospects and projects. – Contraindications and side-effects of the drugs limit the choice of the prophylactic treatment: corticosteroids in a tapering course, verapamil and methysergide are the most useful treatments of the episodic form. Lithium carbonate is more effective for the chronic stage of CH, but side-effects are often troublesome. Numerous other medications have been used for prophylaxis: valproate, capsaicin, beta-blockers. Unfortunately, double-blind studies are often lacking and are difficult to realize due to spontaneous variable remission of episodic CH. When adequate trials of drug therapies show a total resistance to the treatments, surgery may be considered. Radiofrequency trigeminal rhizotomy is the treatment of choice with 70% of beneficial effects. Risks and complications have to be discussed in balance with the benefit of the different surgical procedures.

General considerations on the symptomatic and prophylactic treatment of cluster headache.

General considerations on the symptomatic and prophylactic treatment of cluster headache.

Prophylactic treatment of cluster headache with verapamil.

An open study of verapamil in cluster headache is reported. Forty-eight patients participated in the study of whom 33 (= 69%) improved more than 75%. No significant differences in response were observed between episodic and chronic cluster headache.

Prophylactic treatment of cluster headache with budipine.

SYNOPSISFor two years we have tested the prophylactic efficacy of budipine for the treatment of cluster headache. The open study was carried out on 27 men and 8 women. 23 patients suffered from episodic and 2 from chronic cluster headache. 7 patients had cluster‐migraine, and 3 chronic paroxysmal hemicrania. 20 patients were free of cluster headache attacks 2–6 days after beginning daily prophylactic budipine therapy with 15–60 mg. 14 patients showed a markedly decreased frequency of attacks and the intensity of persisting attacks was diminished. One patient reported only a slight improvement. There were no non‐responders to budipine therapy. 10 patients showed only mild budipine side effects. Budipine was found very effective for treatment of cluster headache.