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. 2019 Dec;19(6):521-528.
doi: 10.1136/practneurol-2018-002124. Epub 2019 Jul 5.

Managing cluster headache

Diana Y Wei  1 , Modar Khalil  1   2 , Peter J Goadsby  3   4
Affiliations

Managing cluster headache

Diana Y Wei et al. Pract Neurol. 2019 Dec.

Abstract

Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Cluster headache attacks often occur more than once a day, and typically manifesting in bouts. It has a point prevalence of 1 in 1000 and is the most common trigeminal autonomic cephalalgia. This article aims to guide general neurologists to an accurate diagnosis and practical management options for cluster headache patients.

Keywords: cluster headache; management; neuromodulation.

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Conflict of interest statement

Competing interests: PJG reports, over the last 36 months, grants and personal fees from Amgen and Eli-Lilly and Company, and personal fees from Alder Biopharmaceuticals, Allergan, Autonomic Technologies Inc., Biohaven Pharmaceuticals Inc., Dr Reddy's Laboratories, Electrocore LLC, eNeura, Impel Neuropharma, MundiPharma, Novartis, Teva Pharmaceuticals, Trigemina Inc., WL Gore, and personal fees from MedicoLegal work, Massachusetts Medical Society, Up-to-Date, Oxford University Press, and Wolters Kluwer; and a patent magnetic stimulation for headache assigned to eNeura without fee.

Figures

Figure 1
Figure 1
Current landscape for cluster headache treatment: the grey boxes indicate the medications that should be phased out, orange boxes indicate neuromodulation techniques. ECH, episodic cluster headache; nVNS, non-invasive vagus nerve stimulator; SPG, sphenopalatine ganglion.
Figure 2
Figure 2
The gammaCore device (A) device shown with electrolyte gel and (B) device demonstration. Image published with permission of the individual.
Figure 3
Figure 3
Right-sided SPG microstimulator from a patient in our centre. (A) Postoperative reconstructed CT scan of head, coronal view, showing the microstimulator in red, with electrode lead in the right pterygopalatine fossa, the body of the neurostimulator with the microprocessor and the RF-antenna (1) and the fixation plate (2), the pink indicates the vidian canal and the blue indicates foramen rotundum. (A) Axial view showing the relation of the VC and the first electrode of the microstimulator (E1). SPG, sphenopalatine ganglion; VC, vidian canal.
Figure 4
Figure 4
The SPG device and the remote controller. The patient activates the stimulator via a hand-held device which the patient puts on the cheek ipsilateral to the pain, the device should be held for 15 min. Courtesy of Autonomic Technologies. SPG, sphenopalatine ganglion
See this image and copyright information in PMC

References

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