Cluster Headache is Still Lurking in the Shadows

Martelletti, Paolo; Curto, Martina

doi:10.1007/s40122-021-00278-5

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Therefore, the benefits of galcanezumab in preventing attacks in episodic CH patients did not outweigh its risks. In these countries, verapamil at high dosages is still used, but its use is limited by its cardiovascular risks, such as atrioventricular block [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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Fremanezumab and Non-High-Dose Galcanezumab for Comorbid Cluster Headache in Patients with Migraine: Three Cases

Kashiwagi¹,

Katsuki²,

Kawamura³

et al. 2023

Neurology International

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A new treatment option for cluster headache (CH) prevention is needed. Monoclonal antibodies (mABs) against calcitonin gene-related peptide (CGRP) ligands are used as a preventative treatment for migraine. Considering the CGRP’s role in the CH attack’s ignition and upkeep, fremanezumab and galcanezumab have been evaluated for CH preventative treatment. However, only high-dose (300 mg) galcanezumab has been approved for episodic CH prevention. We herein report three cases of migraine and comorbid CH with previous failures of preventive treatments. Two cases were treated with fremanezumab and one with non-high-dose galcanezumab. All three cases showed good results, not only for migraine, but also for CH attacks. This report suggests the efficacy of CGRP-mABs for CH prevention. Our cases differed from cases in the phase 3 trials of CGRP-mABs for CH prevention in two ways: first, our patients had both migraine and comorbid CH, and second, we used a combination of CGRP-mABs with preventative drugs, such as verapamil and/or prednisolone, to treat CH. Future accumulation of real-world data may prove the efficacy of CGRP-mABs for CH prevention.

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Section: Discussionmentioning

confidence: 99%

“…Cluster headache (CH) is one of the primary headache disorders. CH attacks are characterized by excruciating unilateral headache or facial pain accompanied by ipsilateral autonomic symptoms and restlessness or agitation [ 1 ]. CH patients suffer from a 60-month diagnostic delay despite the pain’s severity.…”

Section: Introductionmentioning

confidence: 99%

Fremanezumab and Non-High-Dose Galcanezumab for Comorbid Cluster Headache in Patients with Migraine: Three Cases

Kashiwagi¹,

Katsuki²,

Kawamura³

et al. 2023

Neurology International

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“…This makes the correct diagnosis a crucial step towards effective treatment. Worldwide, the diagnosis of cluster headache is often delayed for years [ 115 , 116 ], and even more so in women [ 117 ] and adolescents [ 115 ]. This delay could be more pronounced in countries of the global south, where prevalent health issues like infectious diseases take precedence.…”

Section: Introductionmentioning

confidence: 99%

“…There are also some reports of patients with comorbid migraine and cluster headache, where treatment of migraine with an anti-CGRP antibody improved both migraine and cluster headache [ 132 , 133 ]. In view of the high unmet need of cluster headache patients, associated with substantial suffering, and the limited evidence for existing preventive therapies, the EMA decision seems harsh, and creates substantial inequity [ 116 ].…”

Section: Introductionmentioning

confidence: 99%

Health equity, care access and quality in headache – part 2

Raffaelli,

Rubio-Beltrán,

Cho

et al. 2023

J Headache Pain

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Background Headache disorders are a global public health concern affecting diverse populations. This review examines headache service organizations in low-, middle-, and high-income countries. It addresses global challenges in pharmacological headache treatment, with a focus on safety, tolerability, reproductive and child health, and outlines disparities in accessing innovative treatments worldwide. Main body Organized headache services are essential due to the wide prevalence and varying severity of headache disorders. The tiered headache service model is globally recognized, although its implementation varies based on financial and workforce considerations. Headache burden affects well-being, causing disability, economic challenges, and work limitations, irrespective of location or income. All nations still require improved diagnosis and treatment, and the majority of countries face obstacles including limited access, awareness, economic barriers, and inadequate health policies. Provided adequate internet availability, telemedicine could help improve health equity by expanding access to headache care, since it can offer patients access to services without lengthy waiting times or extensive travel and can provide healthcare unavailable in underserved areas due to staff shortages. Numerous health disparities restrict global access to many headache medications, especially impacting individuals historically excluded from randomized controlled trials, such as those with cardiovascular and cerebrovascular conditions, as well as pregnant women. Furthermore, despite advancements in researching migraine treatments for young patients, the options for treatment remain limited. Access to headache treatment relies on factors like medication availability, approval, financial coverage, and healthcare provider expertise. Inadequate public awareness leads to neglect by policymakers and undertreatment by patients and healthcare providers. Global access discrepancies are exacerbated by the introduction of novel disease-specific medications, particularly impacting Asian, African, and Latin American nations excluded from clinical trials. While North America and Europe experience broad availability of migraine treatments, the majority of countries worldwide lack access to these therapies. Conclusions Healthcare disparities, treatment access, and medication availability are concerning issues in headache medicine. Variations in national healthcare systems impact headache management, and costly innovative drugs are widening these gaps. Healthcare practitioners and experts should acknowledge these challenges and work towards minimizing access barriers for equitable global headache care in the future.

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“…This results in a limited understanding of the triggers and temporal course of the condition. 3,5 Variability in the clinical presentation, 6 misdiagnosis of symptoms as being migraine-related, 7 and the lack of understanding and awareness, 8 particularly among primary care physicians, contribute to diagnostic delays of several years for most patients with cluster headache. 7,9 A recent study identified that up to 50% of patients were diagnosed with cluster headache by a neurologist, indicating that misdiagnosis or inappropriate treatment may have come from other specialists or self-diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Patient-identified burden and unmet needs in patients with cluster headache: An evidence-based qualitative literature review

Freeman

Adair

Beeler³

et al. 2022

Cephalalgia Reports

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Objectives: To qualitatively identify evidence-based literature related to the daily burden and unmet treatment and psychosocial needs of patients with cluster headache (CH). Methods: A literature search was conducted through October 20, 2020 across MEDLINE, EMBASE, CINAHL, and PsychInfo databases exploring quality of life (QoL) and disease burden in adults with CH. The search was restricted to full-text reports in peer-reviewed journals. Methodologic quality was assessed using the Critical Skills Appraisal Program. Results: From 11 identified publications, QoL was reduced in persons living with CH, with significant psychological, social, and socio-economic burdens, and work-related disability. The CH disease trajectory is complex, with patients experiencing the impact of their disease across multiple domains beyond the biological manifestation of the disease including stigma, employment limitations, and suicidal ideation, and with a lack of effective treatment from the patient perspective. Discussion: These findings strengthen comprehension of the CH patient experience, enabling a deeper understanding of the patients’ perspective and experience of their disease andunmet needs, providing a basis for future research into this debilitating condition. Minor limitations of this study include data extraction and study selection biases.

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Cluster Headache is Still Lurking in the Shadows

Cited by 4 publications

References 26 publications

Fremanezumab and Non-High-Dose Galcanezumab for Comorbid Cluster Headache in Patients with Migraine: Three Cases

Fremanezumab and Non-High-Dose Galcanezumab for Comorbid Cluster Headache in Patients with Migraine: Three Cases

Health equity, care access and quality in headache – part 2

Patient-identified burden and unmet needs in patients with cluster headache: An evidence-based qualitative literature review

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