Antiepileptic Drugs for the Treatment of Chronic and Episodic Cluster Headache: A Review

Pascual, Julio; Láinez, Miguel J. A.; Dodick, David W.; Hering-Hanit, Rachel

doi:10.1111/j.1526-4610.2007.00653.x

Cited by 32 publications

(15 citation statements)

References 65 publications

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“…Corticosteroids, lithium, some anticonvulsants, and methysergide also are used. Valproic acid [9], pizotifen, gabapentin [10], baclofen [11], and melatonin [12] have shown some effect in CH prophylaxis and may be used in selected patients as a second-line therapy [13]. Evers [7] recommended that recent advances have been made in treatment of acute attacks by different methods of triptan application.…”

Section: Pharmacotherapy Of Cluster Headachementioning

confidence: 97%

Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache

Kano

Kondziolka

Niranjan

et al. 2010

Curr Pain Headache Rep

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Gamma knife stereotactic radiosurgery (SRS) has proven to be an effective management approach for trigeminal neuralgia and as a minimally invasive alternative management option for cluster headache (CH). In CH, patients undergo single-session focused irradiation of the trigeminal nerve root (TN), sometimes coupled with irradiation of the sphenopalatine ganglion (SPG) as well. SRS provides early pain relief in most patients, but is associated with trigeminal sensory dysfunction in some patients. In the future, a prospective trial that compares a single target of TN to dual targets of both the TN and SPG may provide further understanding of the value of SRS for CH.

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Section: Pharmacotherapy Of Cluster Headachementioning

confidence: 97%

Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache

Kano

Kondziolka

Niranjan

et al. 2010

Curr Pain Headache Rep

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“…Paresthesia of the distal extremities, somnolence, dizziness, cognitive symptoms, balance disturbances, and ataxia were common; mood changes, psychosis, and weight loss also occurred. Glaucoma and nephrolithiasis were less common [34,35]. Patients should be advised to drink at least 2 l of water per day to prevent nephrolithiasis.…”

Section: Second-line Preventives: Topiramatementioning

confidence: 99%

“…In two open-label trials, topiramate was administered at 25 to 200 mg per day [34,35]. In 70% of patients, the drug was moderately or markedly effective at preventing headache attacks, and in some, improvement was evident within 1 to 4 weeks [34, Class IV; 35, Class IV].…”

Section: Second-line Preventives: Topiramatementioning

confidence: 99%

Management of Chronic Cluster Headache

Leone

Franzini

Cecchini

et al. 2010

Curr Treat Options Neurol

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Primary cluster headache (CH) is an excruciatingly severe pain condition. Several pharmacologic agents are available to treat chronic CH, but few double-blind, randomized clinical trials have been conducted on these agents in recent years, and the quality of the evidence supporting their use is often low, particularly for preventive agents. We recommend sumatriptan or oxygen to abort ongoing headaches; the evidence available to support their use is good (Class I). Ergotamine also appears to be an effective abortive agent, on the basis of experience rather than trials. We consider verapamil and lithium to be first-line preventives for chronic CH, although the trial evidence is at best Class II. Steroids are clearly the most effective and quick-acting preventive agents for chronic CH, but long-term steroid use carries a risk of several severe adverse effects. We therefore recommend steroids only if verapamil, lithium, and other preventive agents are ineffective. In rare cases, patients experience multiple daily cluster headaches for years and are also refractory to all medications. These patients almost always develop severe adverse effects from chronic steroid use. Such patients should be considered for neurostimulation. Occipital nerve stimulation is the newest and least invasive neurostimulation technique and should be tried first; the evidence supporting its use is encouraging. Hypothalamic stimulation is more invasive and can be performed only in specialist neurosurgical centers. Published experience suggests that about 60% of patients with chronic CH obtain long-term benefit with hypothalamic stimulation.

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“…In open-label trials, topiramate administered in the range of 25-200 mg per day was moderately or markedly effective at preventing headache attacks in 70% of cases; in a few instances, improvement was fairly rapid (within 1-4 weeks). 34,35 To minimize adverse effects, this drug should be started at 25 mg per day and increased by 25 mg every week. In patients with chronic cluster headache, our experience is that increasing the dosage of topiramate can reduce pain frequency.…”

Section: Third-line Medicationsmentioning

confidence: 99%

Cluster headache: pharmacological treatment and neurostimulation

Leone¹,

Franzini²,

Cecchini³

et al. 2009

Nat Rev Neurol

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Cluster headache is a primary headache syndrome that is characterized by excruciatingly severe, strictly unilateral attacks of orbital, supraorbital or temporal pain, which last 15-180 min and are accompanied by ipsilateral autonomic manifestations (e.g. lacrimation and rhinorrhea). The attacks typically occur with circadian rhythmicity, being experienced at fixed hours of the day or night. In episodic cluster headache, attacks usually occur daily in 6-12-week bouts (cluster periods) followed by remission periods. In chronic cluster headache there is no notable remission. Cluster headache attacks reach full intensity very quickly and abortive agents need to be administered without delay. The pathophysiology of cluster headache is imperfectly understood and treatment has so far been mainly empirical. However, neuroimaging studies have prompted the successful use of hypothalamic stimulation to treat the condition. More recently, the less invasive technique of occipital nerve stimulation has shown promise in drug-refractory chronic cluster headache. This Review discusses both acute and preventive treatments for cluster headache and includes suggestions of how to use the available medications. The rationale, study results and selection criteria for neurostimulation procedures are also summarized, as are the disadvantages of these procedures.

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Antiepileptic Drugs for the Treatment of Chronic and Episodic Cluster Headache: A Review

Cited by 32 publications

References 65 publications

Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache

Gamma Knife Stereotactic Radiosurgery in the Management of Cluster Headache

Management of Chronic Cluster Headache

Cluster headache: pharmacological treatment and neurostimulation

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