Efficacy of transdermal rotigotine in chronic cluster headache: A case series

Cluster headache (CH) is one of the most severe forms of headache, but the number of effective treatments is still limited. Recently, we reported the case of a drug-resistant CH patient responsive to the rotigotine transdermal patch, which is used in the treatment of Parkinson’s disease. This report formed the basis for a case series where other drug-resistant CH patients were treated with rotigotine. Here are the results of this study. Twenty-two CH patients underwent the treatment. Eight were episodic cluster headache (ECH) patients and 14 were chronic cluster headache (CCH) patients. Of the eight ECH patients, four reported that their CH had been stopped by the treatment. Of the 14 CCH patients, 11 were considered responders to the treatment (5 experienced a full resolution of headache, and 6 had a headache reduction of at least 50% in terms of mean monthly number of attacks). Our case series confirms the previous observation that rotigotine could be helpful in the treatment of CH. It may even influence the monoaminergic system that has a key role in the pathogenesis of CH.

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Long-term use of daily sumatriptan injections in severe drug-resistant chronic cluster headache: Table

Neurology ◽

10.1212/wnl.0000000000002117 ◽

2015 ◽

Vol 86 (2) ◽

pp. 194-195 ◽

Cited By ~ 11

Author(s):

Massimo Leone ◽

Alberto Proietti Cecchini

Keyword(s):

Cluster Headache ◽

Chronic Cluster Headache ◽

Drug Resistant

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A prospective case series of sphenopalatine ganglion pulsed radiofrequency therapy for refractory chronic cluster headache

European Journal of Neurology ◽

10.1111/ene.14176 ◽

2020 ◽

Vol 27 (7) ◽

pp. 1190-1196

Author(s):

Z. T. Lazzari ◽

S. Palmisani ◽

B. Hill ◽

A. Al‐Kaisy ◽

G. Lambru

Keyword(s):

Cluster Headache ◽

Case Series ◽

Chronic Cluster Headache ◽

Sphenopalatine Ganglion ◽

Pulsed Radiofrequency ◽

Radiofrequency Therapy ◽

Prospective Case Series

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Clomiphene treatment may be effective in refractory episodic and chronic cluster headache

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170119 ◽

2017 ◽

Vol 75 (9) ◽

pp. 620-624 ◽

Cited By ~ 6

Author(s):

Maria Eduarda Nobre ◽

Mario Fernando Prieto Peres ◽

Pedro Ferreira Moreira Filho ◽

Antonio José Leal

Keyword(s):

Complete Remission ◽

Cluster Headache ◽

Chronic Cluster Headache ◽

Free Time ◽

Chronic Patients ◽

Conventional Medication ◽

Episodic Cluster Headache ◽

Cluster Headaches ◽

Headache Patients

ABSTRACT Objective To describe the evolution of 15 patients who were treated for difficult-to-control episodic and chronic cluster headaches with clomiphene. Methods Clomiphene treatment was used for seven chronic and eight episodic cluster headache patients. The chronic patients were refractory to the medication being used, and the episodic patients, in addition to being resistant to conventional medication, had longer cluster headache periods, exceeding the average time of previous cluster cycles. Our main analysis was of the time to pain-free, complete remission, and the length of pain-free time and complete remission. Results Clomiphene was used for 45-180 days. The average time to being pain-free was 15 days and cluster remission was up to 60 days. The average time between being pain-free until cluster remission was 26 days. Conclusions Clomiphene treatment was significantly efficient. It interrupted chronicity in all patients, suggesting the capability of changing the pattern of attacks. It proved to be safe and well tolerated.

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Hypothalamic Deep Brain Stimulation for Cluster Headache: Experience From a New Multicase Series

Cephalalgia ◽

10.1111/j.1468-2982.2007.01531.x ◽

2008 ◽

Vol 28 (3) ◽

pp. 285-295 ◽

Cited By ~ 122

Author(s):

T Bartsch ◽

MO Pinsker ◽

D Rasche ◽

T Kinfe ◽

F Hertel ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Cluster Headache ◽

Brain Stimulation ◽

Discharge Rate ◽

Therapeutic Option ◽

Case Series ◽

Chronic Cluster Headache ◽

Posterior Hypothalamus ◽

Attack Frequency ◽

Deep Brain

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multi-centre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

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Abnormal tyrosine metabolism in chronic cluster headache

Cephalalgia ◽

10.1177/0333102416640502 ◽

2016 ◽

Vol 37 (2) ◽

pp. 148-153 ◽

Cited By ~ 14

Author(s):

Giovanni D’Andrea ◽

Massimo Leone ◽

Gennaro Bussone ◽

Paola Di Fiore ◽

Andrea Bolner ◽

...

Keyword(s):

Cluster Headache ◽

Plasma Levels ◽

Primary Headache ◽

Chronic Cluster Headache ◽

Predisposing Factor ◽

Episodic Cluster Headache ◽

Tyrosine Metabolism ◽

Low Levels ◽

And Control ◽

Headache Patients

Objective Episodic cluster headache is characterized by abnormalities in tyrosine metabolism (i.e. elevated levels of dopamine, tyramine, octopamine and synephrine and low levels of noradrenalin in plasma and platelets.) It is unknown, however, if such biochemical anomalies are present and/or constitute a predisposing factor in chronic cluster headache. To test this hypothesis, we measured the levels of dopamine and noradrenaline together with those of elusive amines, such as tyramine, octopamine and synephrine, in plasma of chronic cluster patients and control individuals. Methods Plasma levels of dopamine, noradrenaline and trace amines, including tyramine, octopamine and synephrine, were measured in a group of 23 chronic cluster headache patients (10 chronic cluster ab initio and 13 transformed from episodic cluster), and 16 control participants. Results The plasma levels of dopamine, noradrenaline and tyramine were several times higher in chronic cluster headache patients compared with controls. The levels of octopamine and synephrine were significantly lower in plasma of these patients with respect to control individuals. Conclusions These results suggest that anomalies in tyrosine metabolism play a role in the pathogenesis of chronic cluster headache and constitute a predisposing factor for the transformation of the episodic into a chronic form of this primary headache.

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Age at Onset and Sex Ratio in Cluster Headache: Observations Over Three Decades

Cephalalgia ◽

10.1046/j.1468-2982.2002.00318.x ◽

2002 ◽

Vol 22 (2) ◽

pp. 94-100 ◽

Cited By ~ 105

Author(s):

K Ekbom ◽

DA Svensson ◽

H Träff ◽

E Waldenlind

Keyword(s):

Cluster Headache ◽

Age At Onset ◽

Chronic Cluster Headache ◽

Hormone Regulation ◽

Female Ratio ◽

Age Related ◽

Episodic Cluster Headache ◽

Headache Onset ◽

Male Female Ratio ◽

Male Preponderance

Five hundred and fifty-four patients with episodic cluster headache (ECH) and chronic cluster headache (CCH) were examined between 1963 and 1997. Mean age at onset was significantly higher in women with CCH compared with women with ECH and in men with ECH or CCH. In women with CCH age at onset was evenly distributed from 10 to 69 years, whereas in men with CCH and in both sexes with ECH, there was a peak when they were in their 20s. In women with ECH a second peak of onset occurred in their 50s. Although not statistically significant, primary CCH started later in women (mean 50.8 years) than secondary CCH (mean 35.5 years). There was a significant variation in the male : female ratio with respect to age at onset, being largest between 30 and 49 years of age (ECH 7.2 : 1; CCH 11.0 : 1) and lowest after 50 (ECH 2.3 : 1; CCH 0.6 : 1). During the observation period of more than 30 years there was a trend towards a decreasing male preponderance; the male: female ratio was significantly higher among patients with onset before rather than after 1970. The proportion of episodic vs. chronic CH did not change during the study period. The nature of the sex- and age-related pattern of cluster headache onset remains to be elucidated but mechanisms associated with sex hormone regulation, perhaps of hypothalamic origin, may be involved, as well as environmental factors related to lifestyle.

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High-Volume Anesthetic Suboccipital Nerve Blocks for Treatment Refractory Chronic Cluster Headache With Long-Term Efficacy Data: An Observational Case Series Study

Headache The Journal of Head and Face Pain ◽

10.1111/head.13394 ◽

2018 ◽

Vol 59 (1) ◽

pp. 56-62 ◽

Cited By ~ 4

Author(s):

Todd D. Rozen

Keyword(s):

Cluster Headache ◽

Case Series ◽

High Volume ◽

Chronic Cluster Headache ◽

Efficacy Data ◽

Nerve Blocks ◽

Case Series Study ◽

Treatment Refractory ◽

Series Study

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The Incidence and Prevalence of Cluster Headache: A Meta-Analysis of Population-Based Studies

Cephalalgia ◽

10.1111/j.1468-2982.2008.01592.x ◽

2008 ◽

Vol 28 (6) ◽

pp. 614-618 ◽

Cited By ~ 215

Author(s):

M Fischera ◽

M Marziniak ◽

I Gralow ◽

S Evers

Keyword(s):

Sex Ratio ◽

Cluster Headache ◽

Meta Analysis ◽

Epidemiological Studies ◽

Population Based ◽

Chronic Cluster Headache ◽

Lifetime Prevalence ◽

Episodic Cluster Headache ◽

Low Prevalence ◽

Male To Female

Cluster headache is a trigemino-autonomic cephalgia with a low prevalence. Several population-based studies on its prevalence and incidence have been performed, but with different methodology resulting in different figures. We analysed all available population-based epidemiological studies on cluster headache and compared the data in a meta-analysis. The pooled data showed a lifetime prevalence of 124 per 100 000 [confidence interval (CI) 101, 151] and a 1-year prevalence of 53 per 100 000 (CI 26, 95). The overall sex ratio was 4.3 (male to female), it was higher in chronic cluster headache (15.0) compared with episodic cluster headache (3.8). The ratio of episodic vs. chronic cluster headache was 6.0. Our analysis revealed a relatively stable lifetime prevalence, which suggests that about one in 1000 people suffers from cluster headache, the prevalence being independent of the region of the population study. The sex ratio (male to female) is higher than published in several patient-based epidemiological studies.

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