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Review
. 2023 Sep 4;24(1):121.
doi: 10.1186/s10194-023-01660-8.

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments-a consensus article

Nunu Laura Timotheussen Lund  1   2 , Anja Sofie Petersen  3 , Rolf Fronczek  4   5 , Jacob Tfelt-Hansen  6   7 , Andrea Carmine Belin  8 , Tore Meisingset  9   10 , Erling Tronvik  9   10 , Anna Steinberg  11   12 , Charly Gaul  13 , Rigmor Højland Jensen  3
Affiliations
Review

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments-a consensus article

Nunu Laura Timotheussen Lund et al. J Headache Pain. .

Abstract

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.

Keywords: Burden; CGRP; Cluster headache; Review; Treatment; Verapamil.

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Conflict of interest statement

Nunu Lund: Restricted research grant (for institution) from Lundbeck pharma. Personal fee for teaching activities from Dagens Medicin, lægekurser.dk and Master of headache disorders. Support for attending a conference with travel from Pfizer (personal). Anja Petersen: Restricted research grant (for institution) from Lundbeck Pharma. Personal fees from teaching activities from Pfizer. Rolf Fronczek: Research grant from Bioprojet, Jazzpharma, Netherlands Brain Foundation and ZonMW. Advisory board for TEVA, Bioprojet and Lundbeck Pharma (personal fee) and Lilly and Takeda (for institution). Lecture for Novartis (for institution). Secretary, and scientific committee for European Narcolepsy Network. Andrea Carmine Belin: Swedish Brain Foundation & Mellby Gård Foundation, KI founds and foundations and Region Stockholm (ALF project) (for institution). Grant from Swedish Research Council (for institution). Lectures for Novartis, TEVA, Lundbeck and Folkuniversitetet (personal fees). Support for attending meetings/travel from International Headache Society (institution) and O.U.C.H Italia (personal). Trustee for the International Headache Society, Board member – Swedish Headache Society, Board member – Centre for Cluster headache and Chair – International Consortium for Cluster Headache Genetics (unpaid activities). Tore Meisingset: consulting fees from Lundbeck (personal). Lectures for Roche and TEVA (personal fees). Medical device start up from Vilje Bionics AS and Keimon medical AS. Erling Tronvik: Non-personal research funding from several sources: EU, Norwegian Research Council, Dam foundation, KlinBeForsk, The Liaison Committee for education, research and innovation in Central Norway, Nordic AI. IP through NTNU Technology Transfer on several areas: surgical navigation technology, prediction models in machine learning, biofeedback technology. Honoraria from Novartis, Eli Lilly, Abbvie, TEVA, Roche, Lundbeck, Pfizer and Biogen (personal). IP/Patents on several areas: surgical navigation technology, prediction models in machine learning, biofeedback technology. Advisory board: Novartis, Eli Lilly, Abbvie, TEVA, Roche, Lundbeck, Pfizer and Biogen. Board of the Norwegian Headache Society (unpaid), Board of Ottar Sjaastad Migraine Fund (unpaid). Stocks in Man and Science and Nordic Brain Tech. Jacob Tfelt-Hansen: Consulting fee: Johnson and Johnson, Microport, Leo Pharmaceutical, Cytokinetics. Anna Steinberg: nothing to declare. Charly Gaul: Consulting fees from Lundbeck, Novartis, Lilly, Abbvie, TEVA, Sanofi, Reckitt (for institution) and Vectura, Perfood (personal). Lectures for Lundbeck, Novartis, Lilly, Abbvie, TEVA, Sanofi, Reckitt Benckiser, Hormosan (for institution and partly personal). Participation on a Data Safety Monitoring Board or Advisory Board for TEVA (personal). Honorary general secretary of the national headache society (DMKG). Rigmor Højland Jensen: Restricted research grant (for institution) from Lundbeck pharma, Collaborative study on IIH (for institution) from Lundbeck Foundation, Treatment trial on IIH (for institution) from Novo Nordisk Foundation. Advisory board for Lundbeck Pharma (for institution), Personal fee for teaching activities from Pfizer, Teva, Novartis, Abbvie. Chair of Master of Master of Headache Disorders, Director of Danish Headache Center, Director in Lifting The Burden (personal fees or unpaid activities).

Figures

Fig. 1
Fig. 1
Current available treatment options for cluster headache
See this image and copyright information in PMC

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References

    1. Headache Classification Committee of the International Headache Society (IHS) (2018) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1–211. 10.1177/0333102417738202 - PubMed
    1. Burish MJ, Pearson SM, Shapiro RE, Zhang W, Schor LI. Cluster headache is one of the most intensely painful human conditions: Results from the International Cluster Headache Questionnaire. Headache. 2021;61:117–124. doi: 10.1111/head.14021. - DOI - PMC - PubMed
    1. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia. 2008;28:614–618. doi: 10.1111/j.1468-2982.2008.01592.x. - DOI - PubMed
    1. Wei DYT, Yuan Ong JJ, Goadsby PJ. Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. Ann Indian Acad Neurol. 2018;21:S3–S8. doi: 10.4103/aian.AIAN_349_17. - DOI - PMC - PubMed
    1. Wei DY, Goadsby PJ. Cluster headache pathophysiology — insights from current and emerging treatments. Nat Rev Neurol. 2021;17:308–324. doi: 10.1038/s41582-021-00477-w. - DOI - PubMed

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