TY - JOUR

T1 - Current treatment options for cluster headache

T2 - limitations and the unmet need for better and specific treatments—a consensus article

AU - Lund, Nunu Laura Timotheussen

AU - Petersen, Anja Sofie

AU - Fronczek, Rolf

AU - Tfelt-Hansen, Jacob

AU - Belin, Andrea Carmine

AU - Meisingset, Tore

AU - Tronvik, Erling

AU - Steinberg, Anna

AU - Gaul, Charly

AU - Jensen, Rigmor Højland

N1 - Publisher Copyright: © 2023, Springer-Verlag Italia S.r.l., part of Springer Nature.

PY - 2023

Y1 - 2023

N2 - 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. Graphical Abstract: [Figure not available: see fulltext.].

AB - 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. Graphical Abstract: [Figure not available: see fulltext.].

KW - Burden

KW - CGRP

KW - Cluster headache

KW - Review

KW - Treatment

KW - Verapamil

U2 - 10.1186/s10194-023-01660-8

DO - 10.1186/s10194-023-01660-8

M3 - Journal article

C2 - 37667192

AN - SCOPUS:85169692458

VL - 24

JO - Journal of Headache and Pain

JF - Journal of Headache and Pain

SN - 1129-2369

IS - 1

M1 - 121

ER -