Primaries non-migraine headaches treatment: a review
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THERAPEUTICAL SCENARIOS IN HEADACHES
Primaries non-migraine headaches treatment: a review Fabio Frediani 1 & Gennaro Bussone 2
# Fondazione Società Italiana di Neurologia 2020
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. Keywords Tension-type headache . TACs . Cluster headache . Headache therapy
Introduction Treating migraines has always represented the main commitment for the “cephalalgologist” (headache specialist), both for the spread of the disease and for the disability and social burden that the disease entails [1]. The identification of a more homogeneous clinical phenotype, especially with respect to tension-type headache, and the recognition of a precise pathogenetic mechanism have prompted the development over time of empirical therapies and treatment by serendipity in a first time and then increasingly targeted and specific therapies. This is not true for the other forms of primary headaches, in particular for tension-type headache (TTH); despite this high diffusion [2], TTH has a poor phenotypic definition that complicates classification and study [3]. On the other hand, the extreme rarity of trigeminal autonomic cephalalgias (TACs), despite the strong personal and disabling impact of these
* Fabio Frediani [email protected] 1
Headache Center, Neurology and Stroke Unit S. Carlo Hospital, ASST Santi Paolo & Carlo, Via Pio II, N. 3, 20153 Milano, Italy
2
National Neurological Institute Carlo Besta, Milano, Italy
diseases, has always made it difficult to conduct controlled studies on significant samples, with the partial exception of cluster headache. However, it is precisely in these forms of primary headaches that there are some particular and often very significant clinical aspects, which are essential to know in order to correctly orientate in the therapeutic approach.
Tension-type headache The therapeutic approac
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