Evers_EU Neurology 10/03/2010 10:23 Page 97
Advances in Medical Management of Cluster Headache
published suggesting efficacy in the prophylaxis of cluster available, and some procedures can induce trigeminal neuralgia or
headache.
48,49
However, the irritating nature of the nasally applied anaesthesia dolorosa.
62
Unlike in trigeminal neuralgia, surgical
treatment makes the ‘blindness’ of the patient doubtful. treatment of cluster headache is not a causal therapy, and
continuation of cluster headache after the procedure can be
Oral melatonin 10mg was effective in one double-blind, placebo- observed.
63
Recently, deep brain stimulation of the posterior inferior
controlled study.
50
However, in cluster headache refractory to other hypothalamus has been shown to be effective in the majority of
medication, melatonin used open-label did not produce any several samples of patients with intractable cluster headache.
64–67
additional efficacy.
51
Notably, no sufficient evidence for the efficacy Recommendations for the selection of patients for these procedures
of botulinum toxin,
52
transdermal clonidine,
53
misoprostol
54
or have been published recently;
68
however, the clinical role of this
hyperbaric oxygen inhalation
55
in the prophylactic treatment of procedure is yet to be determined.
cluster headache has been obtained. These approaches offer
nothing useful to patients with cluster headache. Conclusion
Cluster headache has become a disorder that, although devastating
Interventional and Surgical Treatment in nature, can be treated effectively. Recent advances have been
The most promising (but still preliminary) advances in the treatment made in acute attack treatment by different types of triptan
of cluster headache have been made in the field of neuromodulation. application. Prophylactic drug treatment, which for a long time used
It has been observed that greater occipital nerve blockade resulted in only verapamil, lithium and steroids, has been extended by the
a significant reduction of cluster headache attacks in about two-thirds introduction of antiepileptic drugs (valproic acid, topiramate). Much
of patients.
56,57
This finding confirmed previous observations, but hope and promise has arisen from the advances in neurostimulation.
needs to be replicated in controlled trials. Suboccipital injection of The future will show whether these advances can be introduced into
long-acting steroids was also shown to be effective in the prophylaxis clinical practice. n
of cluster headache in a double-blind, placebo-controlled trial.
58
These
findings induced open clinical trials on occipital nerve stimulation in
refractory cluster headache. These trials showed improvement in the
Stefan Evers is a Professor of Neurology and Clinical
Neurophysiology and a Consultant in the Department of
majority of patients.
59–61
Neurology at the University of Münster. He is also Head
of the Headache and Epilepsy Clinics at the same
If all drugs are ineffective, contraindicated or not tolerated, and a
institution. Professor Evers is Vice President of the
German Migraine and Headache Society and Chair of
secondary cluster headache has been excluded, surgical treatment the Headache Panel of the European Federation of
may be suggested. Surgical procedures should be treated with great
Neurological Societies.
caution because no reliable long-term observational data are
1. Headache Classification Committee of the International 24. Magnoux E, Zlotnik G, Headache, 2004;44:249–55. 47. Mulder LJ, Spierings EL, Cephalalgia, 2002;22:815–17.
Headache Society, Cephalalgia, 2004;24(Suppl. 1):1–160. 25. Kittrelle JP, et al., Arch Neurol, 1985;42: 496–8. 48. Marks DR, et al., Cephalalgia, 1993;13:114–16.
2. Fischera M, et al., Cephalalgia, 2008;28:614–18. 26. Mills TM, Scoggin JA, Ann Pharmacother, 1997;31:914–15. 49. Saper JR, et al., Arch Neurol, 2002;59:990–94.
3. Russell MB, Lancet Neurol, 2004;3:279–83. 27. Robbins L, Headache, 1995;35:83–4. 50. Leone M, et al., Cephalalgia, 1996;16:494–6.
4. Evers S, et al., Cephalalgia, 2002;22:160–62. 28. Costa A, et al., Cephalalgia, 2000;20: 85–91. 51. Pringsheim T, et al., Headache, 2002;42:787–92.
5. Bahra A, et al., Neurology, 2002;58:354–61. 29. Matharu MS, et al., Ann Neurol, 2004;56:488–94. 52. Evers S, Curr Opin Otolaryngol Head Neck Surg, 2004;12:197–203.
6. May A, Leone M, Curr Opin Neurol, 2003;16:333–40. 30. Paemeleire K, et al., Neurology, 2006;67: 109–13. 53. Leone M, et al., Headache, 1997;37:559–60.
7. Kudrow L, Headache, 1981;21:1–4. 31. May A, et al.; EFNS Task Force, Eur J Neurol, 54. Evers S, et al., Headache, 1998;38:618–20.
8. Fogan L, Arch Neurol, 1985;42:362–3. 2006;13;1066–77. 55. Nilsson Remahl AI, et al., Cephalalgia, 2002;22:730–39.
9. The Sumatriptan Cluster Headache Study Group, N Engl J 32. Bussone G, et al., Headache, 1990;30:411–17. 56. Anthony M. In: Rose C (ed.), Migraine, Basel: Karger,
Med, 1991;325:322–6. 33. Leone M, et al., Neurology, 2000;54:1382–5. 1985;169–73.
10. Ekbom K, et al., Acta Neurol Scand, 1993;88:63–9. 34. Cohen AS, et al., Neurology, 2007;69: 668–75. 57. Peres MF, et al., Cephalalgia, 2002;22:520–22.
11. Ekbom K, et al., Cephalalgia, 1995;15:230–36. 35. Matharu MS, et al., J Neurol Neurosurg Psychiatry, 58. Ambrosini A, et al., Pain, 2005;118:92–6.
12. Göbel H, et al., Neurology, 1998;51:908–11. 2005;76:124–7. 59. Magis D, et al., Lancet Neurol, 2007;6:314–21.
13. Krabbe A, Cephalalgia, 1989;9(Suppl. 10):404–5. 36. Ekbom K, Headache, 1981;21:132–9. 60. Burns B, Lancet, 2007;369:1099–1106.
14. Gregor N, et al., Headache, 2005;45:1069–72. 37. Steiner TJ, et al., Cephalalgia, 1997;17:673–5. 61. Schwedt TJ, et al., Cephalalgia, 2007;27:153–7.
15. Schuh-Hofer S, et al., J Neurol, 2002;249:94–9. 38. Manzoni GC, et al., Cephalalgia, 1983;3:109–14. 62. Ekbom K, Solomon S. In: Olesen J, Tfelt-Hansen P, Welch
16. Van Vliet JA, et al., Neurology, 2003;60:630–33. 39. Gallagher RM, et al., J Am Osteopath Assoc, 2002;102:92–4. KMA (eds), The Headaches, Philadelphia: Lippincott,
17. Bahra A, et al., Neurology, 2000;54:1832–9. 40. Hering R, Kuritzky A, Cephalalgia, 1989;9:195–8. 2000;731–40.
18. Cittadini, et al., Arch Neurol, 2006;63:1537–42. 41. El Amrani M, et al., Cephalalgia, 2002;22:205–8. 63. Matharu MS, Goadsby PJ, Brain, 2002;125:976–84.
19. Rapoport AM, et al., Neurology, 2007;69:821–6. 42. Förderreuther S, et al., Cephalalgia, 2002;22:186–9. 64. Franzini A, et al., Neurosurgery, 2003;52: 1095–1101.
20. Horton BT, et al., Mayo Clin Proc, 1948;23:104–8. 43. Láinez MJ, et al., Headache, 2003;43: 784–9. 65. Schoenen J, et al., Brain, 2005;128:940–47.
21. Kunkle EC, et al., Trans Am Neurol Assoc, 1952;77:240–43. 44. Leone M, et al., Cephalalgia, 2003;23:1001–2. 66. Starr PA, et al., J Neurosurg, 2007;106:999–1005.
22. Friedman AP, Mikropoulos HE, Neurology, 1958;8:653–63. 45. Monstad I, et al., Headache, 1995;35:607–13. 67. Bartsch T, et al., Cephalalgia, 2008;28:285–95.
23. Andersson PG, Jespersen LT, Cephalalgia, 1986;6:51–4. 46. Zebenholzer K, et al., Headache, 2004; 44:361–4. 68. Leone M, et al., Cephalalgia, 2004;24:934–7.
EUROPEAN NEUROLOGICAL REVIEW 97
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