Recent Advances in the Management of Cluster Headache
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Headache (J Couch, Section Editor)
Recent Advances in the Management of Cluster Headache MarU´a Dolores Villar-MartU´nez, MD1,2 Francesca Puledda, MD1,2 Peter J. Goadsby, MD, PhD, DSc1,2,* Address 1 Department of Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK *,2 NIHR-Wellcome Trust King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK Email: [email protected]
* The Author(s) 2020
This article is part of the Topical Collection on Headache Keywords Cluster headache I Calcitonin gene-related peptide I Neuromodulation I Vagal nerve stimulation I Sphenopalatine ganglion stimulation
Abstract Purpose of review Among the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance.Recent findings While classic firstline medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better tolerability and decreased medication interactions have proven to be effective. A remarkable example of this is the blockage of the calcitonin gene-related peptide pathway with monoclonal antibodies, which may be a key element in the future treatment of cluster headache. The sphenopalatine ganglion and vagus nerve perform a critical role in the regulation of pain and the trigeminal autonomic reflex. Neuromodulation therapies targeting these structures have shown excellent tolerability and few significant adverse events, constituting a promising form of treatment. Finally, several potential therapeutic targets are examined in this review, such as small molecule CGRP receptor antagonists, known as gepants, and serotonin receptor 5-HT1F receptor agonists: ditans.Summary In summary, a deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.
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Curr Treat Options Neurol
(2020) 22:46
Introduction Cluster headache (CH) is a relatively rare primary headache disorder. It is the most common of the trigeminal autonomic cephalalgias (TACs) [1], with a population prevalence of approximately 0.1% [2, 3]. It is characterized by attacks of unilateral head pain that escalates rapidly [4], generally located in the orbital and supraorbital region, associated with ipsilateral cranial autonomic symptoms, such as conjunctival injection, lacrimation, rhinorrhoea and nasal congestion [5]. Some patients also report characteristically lateralized associated symptoms, such as photophobia or phonophobia [6
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