Cluster Headache: Potential Options for Medically Refractory Patients (When All Else Fails)

Tepper, Stewart J.; Stillman, Mark J.

doi:10.1111/head.12148

Cited by 18 publications

(16 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other therapies with reports of efficacy in the treatment of CH that did not satisfy the inclusion criteria for our systematic review have been either recommended by other guidelines, discussed as therapeutic options in expert opinions, or reported in case series or open label studies . Such treatments include methysergide, methylergonovine, flunarizine, topiramate, gabapentin, baclofen, clonidine, pizotifen, histamine sulfate, kudzu, 2‐bromo lysergic acid diethylamide, hormonal therapies such as testosterone and clomiphene, as well as interventional therapies such as botulinum toxin injections, sphenopalatine ganglion blockade, and radiofrequency ablation.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

et al. 2016

View full text Add to dashboard Cite

Background.-Cluster headache (CH), the most common trigeminal autonomic cephalalgia, is an extremely debilitating primary headache disorder that is often not optimally treated. New evidence-based treatment guidelines for CH will assist clinicians with identifying and choosing among current treatment options.Objectives.-In this systematic review we appraise the available evidence for the acute and prophylactic treatment of CH, and provide an update of the 2010 American Academy of Neurology (AAN) endorsed systematic review.Methods.-Medline, PubMed, and EMBASE databases were searched for double-blind, randomized controlled trials that investigated treatments of CH in adults. Exclusion and inclusion criteria were identical to those utilized in the 2010 AAN systematic review.Results and Recommendations.-For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine ganglion stimulation was added to the current guideline and has been administered a Level B recommendation for acute treatment. For prophylactic therapy, previously there were no treatments that were administered a Level A recommendation. For the current guidelines, suboccipital steroid injections have emerged as the only treatment to receive a Level A recommendation with the addition of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation (positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U recommendation (frovatriptan).Conclusions.-This AHS guideline can be utilized for understanding which therapies have superiority to placebo or sham treatment in the management of CH. In clinical practice, these recommendations should be considered in concert with other variables including safety, side effects, patient preferences, clinician experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level A recommendations, particularly for a number of commonly used preventive therapies, further studies are warranted to demonstrate safety and efficacy for established and emerging therapies.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The most common indication for this procedure in headache practice has been CH, probably since the SPG has a major role in cranial parasympathetic outflow, raising the notion that it may be involved in CH pathophysiology . Reports on the use of cocaine to block the SPG for the treatment of headaches (that were likely CH) date back more than a century . Intranasal lidocaine has been more commonly used to block the SPG, due to its more favorable safety profile, and the risk of addiction associated with cocaine use.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The efficacy of SPG block in the treatment of CH has been examined in a number of studies over the past several decades . The majority of those studies were open and uncontrolled.…”

Section: Pathophysiologymentioning

confidence: 99%

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

et al. 2015

View full text Add to dashboard Cite

The sphenopalatine ganglion (SPG) has attracted the interest of practitioners treating head and face pain for over a century because of its anatomical connections and role in the trigemino-autonomic reflex. In this review, we discuss the anatomy of the SPG, as well as what is known about its role in the pathophysiology of headache disorders, including cluster headache and migraine. We then address various therapies that target the SPG, including intranasal medication delivery, new SPG blocking catheter devices, neurostimulation, chemical neurolysis, and ablation procedures.

show abstract

“…Since the SPG has a major role in cranial parasympathetic outflow, it has been hypothesized that modulating the activity of this ganglion may be effective in the treatment of headaches associated with prominent cranial autonomic symptoms . Based on this notion, SPG blockade has been most commonly used for patients with CH . The efficacy of SPG blockade for CH has been shown in a number of studies .…”

Section: Discussionmentioning

confidence: 99%

Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report

Krebs

Ashkenazi

2016

Headache

View full text Add to dashboard Cite

show abstract

Cluster Headache: Potential Options for Medically Refractory Patients (When All Else Fails)

Cited by 18 publications

References 44 publications

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

Treatment of Cluster Headache: The American Headache Society Evidence‐Based Guidelines

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report

Contact Info

Product

Resources

About