scholarly journals Effectiveness of medication in cluster headache

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Johannes Drescher ◽  
Andreas Khouri ◽  
Tina Katharina Amann ◽  
Charly Gaul ◽  
Peter Kropp ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Citizen Science ◽  
Chronic Cluster Headache ◽  
Chi Square ◽  
Episodic Cluster Headache ◽  
Acute Medication ◽  
Zolmitriptan Nasal Spray ◽  
Effect Of Oxygen ◽  
Citizen Science Project ◽  
Better Than

Abstract Background The aim of this work is to analyze the reports on cluster headache attacks collected online in the citizen science project CLUE with respect to the effectiveness of drugs taken during the attacks. The collection of data within the framework of citizen science projects opens up the possibility of investigating the effectiveness of acute medication on the basis of a large number of individual attacks instead of a simple survey of patients. Methods Data from 8369 cluster headache attacks, containing information about acute medication taken and the assessment of its effect, were collected from 133 participants using an online platform and a smartphone app. Chi-square tests were used to investigate whether the effect of the three recommended acute drugs differs when distinguishing between participants with chronic or episodic cluster headache. Furthermore, it was investigated whether there are differences between smokers and non-smokers in the assessment of the effect of the acute medication. Results Our participants rated the effectiveness of sumatriptan 6 mg s.c. as significantly better than oxygen and zolmitriptan nasal spray. Oxygen is considered to be significantly better in episodic versus chronic cluster headache, and sumatriptan is considered to be significantly better in chronic versus episodic cluster headache. Smokers rate the effect of oxygen as significantly better than non-smokers. Conclusions Despite some methodological limitations, web-based data collection is able to support findings from clinical trials in a real world setting about effectiveness of acute cluster headache treatment in several situations.

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

2018 ◽  
Vol 1 ◽  
pp. 251581631880969
Author(s):  
Cherubino Di Lorenzo ◽  
Lanfranco Pellesi ◽  
Gianluca Coppola ◽  
Vincenzo Parisi ◽  
Maurizio Evangelista ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Case Series ◽  
Chronic Cluster Headache ◽  
Drug Resistant ◽  
Transdermal Patch ◽  
Full Resolution ◽  
Episodic Cluster Headache ◽  
Monoaminergic System ◽  
Rotigotine Transdermal Patch ◽  
Effective Treatments

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.

Pharmacotherapy Options for the Management of Cluster Headache

2013 ◽  
Vol 5 ◽  
pp. CMT.S10251 ◽  
Author(s):  
Jared L. Pomeroy ◽  
Michael J. Marmura
Keyword(s):  
Adverse Events ◽  
Cluster Headache ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Good Evidence ◽  
Unilateral Headache ◽  
Acute Medication ◽  
Subcutaneous Sumatriptan ◽  
Zolmitriptan Nasal Spray ◽  
Effective Medication

Cluster headache is a primary headache syndrome characterized by attacks of severe unilateral headache typically lasting 30 to 180 minutes without treatment and prominent autonomic symptoms on the affected side. Often attacks occur in cycles lasting weeks to months with up to 8 attacks per day, and a minority of individuals continue to experience attacks throughout the year. Persons with cluster headache usually require both acute medication for attacks and preventive treatment to keep the headaches from occurring. Subcutaneous sumatriptan is the most effective medication for acute cluster attacks, but other triptans such as zolmitriptan nasal spray are also effective. inhaling 100% oxygen is also effective and is a useful treatment for those with frequent attacks or contraindications to triptans. Corticosteroids are among the most effective transitional treatments, typically used at the start of a cycle. Dihydroergotamine is an effective treatment for refractory or severe cluster headache with multiple attacks requiring large triptan doses. Verapamil and lithium are among the most effective preventive medications with good evidence of effectiveness, but other studies support the use of gabapentin, topiramate, diavalproex sodium, and methysergide, to name a few. Each of these medications requires monitoring for adverse events and can be discontinued within a few weeks of a cluster headache cycle.

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

2017 ◽  
Vol 75 (9) ◽  
pp. 620-624 ◽  
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.

Abnormal tyrosine metabolism in chronic cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 148-153 ◽  
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.

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

Cephalalgia ◽  
2002 ◽  
Vol 22 (2) ◽  
pp. 94-100 ◽  
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.

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

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 614-618 ◽  
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.

Pre-attack signs and symptoms in cluster headache: Characteristics and time profile

Cephalalgia ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 1128-1137 ◽  
Author(s):  
Agneta Snoer ◽  
Nunu Lund ◽  
Rasmus Beske ◽  
Rigmor Jensen ◽  
Mads Barloese
Keyword(s):  
Cluster Headache ◽  
Signs And Symptoms ◽  
Structured Interview ◽  
Chronic Cluster Headache ◽  
Time Profile ◽  
Chronic Patients ◽  
Prodromal Phase ◽  
Cluster Headache Attack ◽  
Episodic Cluster Headache ◽  
Accompanying Symptoms

Introduction In contrast to the premonitory phase of migraine, little is known about the pre-attack (prodromal) phase of a cluster headache. We aimed to describe the nature, prevalence, and duration of pre-attack symptoms in cluster headache. Methods Eighty patients with episodic cluster headache or chronic cluster headache, according to ICHD-3 beta criteria, were invited to participate. In this observational study, patients underwent a semi-structured interview where they were asked about the presence of 31 symptoms/signs in relation to a typical cluster headache attack. Symptoms included previously reported cluster headache pre-attack symptoms, premonitory migraine symptoms and accompanying symptoms of migraine and cluster headache. Results Pre-attack symptoms were reported by 83.3% of patients, with an average of 4.25 (SD 3.9) per patient. Local and painful symptoms, occurring with a median of 10 minutes before attack, were reported by 70%. Local and painless symptoms and signs, occurring with a median of 10 minutes before attack, were reported by 43.8% and general symptoms, occurring with a median of 20 minutes before attack, were reported by 62.5% of patients. Apart from a dull/aching sensation in the attack area being significantly ( p < 0.05) more frequent among men and episodic patients, compared with women and chronic patients respectively, no other differences in the prevalence of pre-attack symptoms were identified between groups. Conclusion Pre-attack symptoms are frequent in cluster headache. Since the origin of cluster headache attacks is still unresolved, studies of pre-attack symptoms could contribute to the understanding of cluster headache pathophysiology. Furthermore, identification and recognition of pre-attack symptoms could potentially allow earlier abortive treatment.

Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: Two Case Reports

Cephalalgia ◽  
1992 ◽  
Vol 12 (5) ◽  
pp. 318-320 ◽  
Author(s):  
Alain Djacoba Tehindrazanarivelo ◽  
Jean Marc Visy ◽  
Marie-Germaine Bousser
Keyword(s):  
Complete Remission ◽  
Cluster Headache ◽  
Case Reports ◽  
Chronic Cluster Headache ◽  
Paroxysmal Hemicrania ◽  
Dramatic Improvement ◽  
Episodic Cluster Headache ◽  
Close Relationship ◽  
Chronic Paroxysmal Hemicrania

We report two patients with ipsilateral attacks of cluster headache and chronic paroxysmal hemicrania. The first patient, a 33-year-old man, started having attacks of chronic cluster headache at the age of 27. At 33, they were replaced by typical attacks of ipsilateral chronic paroxysmal hemicrania which showed a dramatic improvement with indomethacin 150 mg daily. After two days of complete remission, cluster headache attacks reappeared and persisted until verapamil, 360 mg a day, was added to indomethacin. The second patient, a 45-year-old man, first developed attacks of episodic cluster headache at the age of 35. At 44, he experienced ipsilateral typical attacks of chronic paroxysmal hemicrania, and two months later attacks of cluster headache. Under verapamil 240 mg daily, attacks of cluster headache disappeared, but those of chronic paroxysmal hemicrania increased in frequency until indomethacin 150 mg daily was added. These observations suggest a close relationship but not a similarity between cluster headache and chronic paroxysmal hemicrania, and show the practical therapeutic interest of maintaining this distinction. Cluster headache, chronic paroxysmal hemicrania, indomethacin, verapamil

scholarly journals Efficacy and safety of oral zolmitriptan in the preictal phase of episodic cluster headache

2021 ◽  
Author(s):  
Wei Liu ◽  
Jiajie Lu ◽  
Xiaoning Guo ◽  
Chunyang Xu ◽  
Manyun Yan ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Adverse Reactions ◽  
Pearson Correlation ◽  
T Test ◽  
Common Symptom ◽  
Efficacy And Safety ◽  
Chi Square ◽  
Neck Stiffness ◽  
Episodic Cluster Headache ◽  
Acute Headache

Abstract BackgroundRecent studies on cluster headache suggested that headache includes three phases.Oral zolmitriptan is effective in the treatment of acute headache attack.We aim to describe the clinical characteristics of different phases of episodic cluster headache(eCH) and observe the efficacy and safety of oral zolmitriptan in preictal phase of eCH attacks.MethodsForty-eight patients with eCH were enrolled in this study. We divided the CH attack into three phases: preictal, ictal and postictal phase and analyzed the clinical features of each phase. We collected the data of twenty-three patients who took zolmitriptan in the preictal phase of three consecutive CH attacks. The Visual Analogue Scale (VAS) score and duration of headache after three consecutive treatments were compared with the baseline respectively. Chi square test, t test, Mann Whitney U test, Pearson linear correlation analysis, paired t-test and paired non-parametric rank-sum test were used for statistical analysis.ResultsForty-five patients (93.8%) reported the presence of preictal symptoms. The most frequent preictal symptom was mild to moderate head discomfort in the area of the subsequent serious headache, accounting for 87.5%. The duration of preictal period was positively correlated with the duration of headache. The Pearson correlation coefficient was 0.313 (P=0.018). Among the twenty-three patients taking oral zolmitriptan in the preictal phase, the VAS max score was significantly lower than that of baseline headache (P<0.01). The duration of headache after three preictal administration was significantly shorter than that of baseline headache (P<0.01). The incidence of adverse reactions after taking zolmitriptan was 10.1%, including head drowsiness, neck stiffness and mild chest tightness.Conclusions Preictal symptoms were common in CH. Mild to moderate discomfort in the subsequent serious headache was the most common symptom in the preictal phase. Oral administration of zolmitriptan in the preictal period could reduce the severity of headache and shorten the duration of headache in a cluster period without serious adverse reactions.

Cluster Headache Course Over Ten Years in 189 Patients

Cephalalgia ◽  
1991 ◽  
Vol 11 (4) ◽  
pp. 169-174 ◽  
Author(s):  
Gian Camillo Manzoni ◽  
Giuseppe Micieli ◽  
Franco Granella ◽  
Cristina Tassorelli ◽  
Carla Zanferrari ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Disease Duration ◽  
Chronic Cluster Headache ◽  
Chronic Patients ◽  
Chronic Form ◽  
Prophylactic Drugs ◽  
Long Duration ◽  
Episodic Cluster Headache ◽  
The Moment ◽  
Headache Patients

One-hundred-and-eighty-nine cluster headache patients, referred to Parma and Pavia Headache Centres between 1976 and 1986 with a disease duration of over 10 years, were interviewed about the course of cluster headache. They were classified as episodic (n = 140) or chronic (n = 49) cluster headache patients on the basis of course during the year of onset. Episodic patients showed the following outcome: maintenance of an episodic form (primary episodic form) in 80.7% of cases, shift towards a chronic form (secondary chronic form) in 12.9% and shift towards an intermediate pattern (“combined” form) in 6.4%. In chronic patients, cluster headache was still chronic (primary chronic form) at the moment of observation in 52.4% of cases, while it turned into an episodic form (“secondary” episodic form) in 32.6% and into a “combined” form in 14.3%. Nineteen patients (10%) had had no attacks for at least three years at the moment of examination. We can conclude from our data that: cluster headache is a disease of long duration, perhaps lifelong; episodic cluster headache tends to worsen; chronic cluster headache may easily turn into a better prognostic episodic form; prophylactic drugs are unable to induce recovery. The following factors seem related to a poor outcome: a later onset, the male gender and a disease duration of over 20 years for the episodic forms.

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