Melatonin in the Preventive Treatment of Chronic Cluster Headache

Cephalalgia ◽  
2001 ◽  
Vol 21 (10) ◽  
pp. 993-995 ◽  
Author(s):  
MFP Peres ◽  
TD Rozen
Keyword(s):  
Cluster Headache ◽  
Eye Movement ◽  
Preventive Treatment ◽  
Headache Disorder ◽  
Chronic Cluster Headache ◽  
Melatonin Secretion ◽  
Sleep Phase ◽  
Autonomic Symptoms ◽  
Head Pain ◽  
Headache Patients

Cluster headache is a stereotypic headache disorder marked by short-lasting bouts of severe unilateral head pain and associated autonomic symptoms. Almost pathognomonic of this condition are nocturnal attacks that usually occur during the first random eye movement sleep phase of the evening. Melatonin levels have been found to be decreased in cluster headache patients. A lack of melatonin secretion may predispose the cluster sufferer to nocturnal and, possibly, daytime attacks. Leone et al. demonstrated that melatonin could rapidly alleviate cluster attacks, but only in episodic cluster patients. We report two chronic cluster headache patients who had both daytime and nocturnal attacks that were alleviated with melatonin.

Cluster Headache

Cephalalgia ◽  
2000 ◽  
Vol 20 (9) ◽  
pp. 787-803 ◽  
Author(s):  
DW Dodick ◽  
TD Rozen ◽  
PJ Goadsby ◽  
SD Silberstein
Keyword(s):  
Gender Differences ◽  
Cluster Headache ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Headache ◽  
Headache Disorder ◽  
Autonomic Symptoms ◽  
Head Pain ◽  
Primary Headache Disorder

Cluster headache is a stereotypic, primary headache disorder that is marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Cluster headache is probably due to an abnormality in the circadian hypothalamic generator with subsequent trigeminovascular activation. We have reviewed the clinical manifestations, pathophysiology, gender differences, and treatment options in cluster headache.

scholarly journals Effect of calcitonin gene-related peptide (-receptor) antibodies in chronic cluster headache: Results from a retrospective case series support individual treatment attempts

Cephalalgia ◽  
2020 ◽  
Vol 40 (14) ◽  
pp. 1574-1584 ◽  
Author(s):  
Ruth Ruscheweyh ◽  
Gregor Broessner ◽  
Gudrun Goßrau ◽  
Katja Heinze-Kuhn ◽  
Tim P Jürgens ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Calcitonin Gene Related Peptide ◽  
Chronic Cluster Headache ◽  
Individual Treatment ◽  
Attack Frequency ◽  
Peptide Receptor ◽  
Related Peptide ◽  
Calcitonin Gene ◽  
Receptor Antibodies ◽  
Headache Patients

Objective To assess the efficacy of monoclonal antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor in chronic cluster headache (CCH) treatment under real world conditions. Background Calcitonin gene-related peptide has an important pathophysiological role in cluster headache. Although the randomised controlled trial with the calcitonin gene-related peptide antibody galcanezumab was negative, chronic cluster headache patients with insufficient response to other preventive treatments have been receiving individual off-label treatment attempts with calcitonin gene-related peptide-(receptor) antibodies. Methods Data from 22 chronic cluster headache patients who received at least one dose of a calcitonin gene-related peptide(-receptor) antibody and recorded attack frequency in a headache diary were retrospectively collected at eight headache centres. Results The number of previous preventive therapies was 6.5 ± 2.4 (mean ± standard deviation, range: 2–11). The average number of attacks per week was 23.3 ± 16.4 at baseline and significantly decreased by −9.2 ± 9.7 in the first month of treatment with a calcitonin gene-related peptide(-receptor) antibody ( p < 0.001). Fifty-five percent of the patients were 50% responders and 36% were 75% responders with respect to attack frequency. Significant reduction of attack frequency started at week 1 (−6.8 ± 2.8 attacks, p < 0.01). Results were corroborated by significant decreases in weekly uses of acute headache medication (−9.8 ± 7.6, p < 0.001) and pain intensity during attacks (−1.2 ± 2.0, numerical rating scale (NRS) [0–10], p < 0.01) in the first month. In months 2 (n = 14) and 3 (n = 10), reduction of attack frequency from baseline was −8.0 ± 8.4 ( p = 0.004) and −9.1 ± 10.0 ( p = 0.024), respectively. Conclusion Under real-world conditions, individual treatment with calcitonin gene-related peptide(-receptor) antibodies was effective in 55% of our chronic cluster headache patients. This finding supports individual off-label treatment attempts with calcitonin gene-related peptide-(receptor) antibodies in chronic cluster headache patients insufficiently responding to other therapies.

scholarly journals Clomiphene treatment may be effective in refractory episodic and chronic cluster headache

2017 ◽  
Vol 75 (9) ◽  
pp. 620-624 ◽  
Author(s):  
Maria Eduarda Nobre ◽  
Mario Fernando Prieto Peres ◽  
Pedro Ferreira Moreira Filho ◽  
Antonio José Leal
Keyword(s):  
Complete Remission ◽  
Cluster Headache ◽  
Chronic Cluster Headache ◽  
Free Time ◽  
Chronic Patients ◽  
Conventional Medication ◽  
Episodic Cluster Headache ◽  
Cluster Headaches ◽  
Headache Patients

ABSTRACT Objective To describe the evolution of 15 patients who were treated for difficult-to-control episodic and chronic cluster headaches with clomiphene. Methods Clomiphene treatment was used for seven chronic and eight episodic cluster headache patients. The chronic patients were refractory to the medication being used, and the episodic patients, in addition to being resistant to conventional medication, had longer cluster headache periods, exceeding the average time of previous cluster cycles. Our main analysis was of the time to pain-free, complete remission, and the length of pain-free time and complete remission. Results Clomiphene was used for 45-180 days. The average time to being pain-free was 15 days and cluster remission was up to 60 days. The average time between being pain-free until cluster remission was 26 days. Conclusions Clomiphene treatment was significantly efficient. It interrupted chronicity in all patients, suggesting the capability of changing the pattern of attacks. It proved to be safe and well tolerated.

REPRINTED WITH PERMISSION OF IASP - Allodynia in cluster headache

Ból ◽  
2019 ◽  
Vol 19 (3) ◽  
pp. 1-8
Author(s):  
Leopoldine A. Wilbrink ◽  
Mark A. Louter ◽  
Onno P.M. Teernstra ◽  
Erik W. van Zwet ◽  
Frank J.P.M. Huygen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cluster Headache ◽  
Central Sensitization ◽  
Treatment Options ◽  
Age At Onset ◽  
Headache Disorder ◽  
Female Gender ◽  
Chronic Cluster Headache ◽  
Cutaneous Allodynia ◽  
Study Participants

Cutaneous allodynia is an established marker for central sensitization in migraine. There is debate whether cutaneous allodynia may also occur in cluster headache, another episodic headache disorder. Here, we examined the presence and severity of allodynia in a large well-defined nationwide population of people with cluster headache. Using validated questionnaires we assessed, crosssectionally, ictal allodynia and comorbid depression and migraine in the nationwide “Leiden University Cluster headache neuro-Analysis” (LUCA) study. Participants with cluster headache were diagnosed according to the International Classification of Headache Disorders criteria. Multivariate regression models were used, with correction for demographic factors and cluster headache subtype (chronic vs episodic; recent attacks ,1 month vs no recent attacks). In total, 606/798 (75.9%) participants with cluster headache responded; of whom, 218/606 (36%) had allodynia during attacks. Female gender (odds ratio [OR] 2.05, 95% confidence interval [95% CI] 1.28-3.29), low age at onset (OR 0.98, 95% CI 0.96-0.99), lifetime depression (OR 1.63, 95% CI 1.06-2.50), comorbid migraine (OR 1.96, 95% CI 1.02-3.79), and having recent attacks (OR 1.80, 95% CI 1.13-2.86), but not duration of attacks and chronic cluster headache, were independent risk factors for allodynia. The high prevalence of cutaneous allodynia with similar risk factors for allodynia as found for migraine suggests that central sensitization, like in migraine, also occurs in cluster headache. In clinical practice, awareness that people with cluster headache may suffer from allodynia can in the future be an important feature in treatment options.

Abnormal tyrosine metabolism in chronic cluster headache

Cephalalgia ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Giovanni D’Andrea ◽  
Massimo Leone ◽  
Gennaro Bussone ◽  
Paola Di Fiore ◽  
Andrea Bolner ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Plasma Levels ◽  
Primary Headache ◽  
Chronic Cluster Headache ◽  
Predisposing Factor ◽  
Episodic Cluster Headache ◽  
Tyrosine Metabolism ◽  
Low Levels ◽  
And Control ◽  
Headache Patients

Objective Episodic cluster headache is characterized by abnormalities in tyrosine metabolism (i.e. elevated levels of dopamine, tyramine, octopamine and synephrine and low levels of noradrenalin in plasma and platelets.) It is unknown, however, if such biochemical anomalies are present and/or constitute a predisposing factor in chronic cluster headache. To test this hypothesis, we measured the levels of dopamine and noradrenaline together with those of elusive amines, such as tyramine, octopamine and synephrine, in plasma of chronic cluster patients and control individuals. Methods Plasma levels of dopamine, noradrenaline and trace amines, including tyramine, octopamine and synephrine, were measured in a group of 23 chronic cluster headache patients (10 chronic cluster ab initio and 13 transformed from episodic cluster), and 16 control participants. Results The plasma levels of dopamine, noradrenaline and tyramine were several times higher in chronic cluster headache patients compared with controls. The levels of octopamine and synephrine were significantly lower in plasma of these patients with respect to control individuals. Conclusions These results suggest that anomalies in tyrosine metabolism play a role in the pathogenesis of chronic cluster headache and constitute a predisposing factor for the transformation of the episodic into a chronic form of this primary headache.

Evaluation of guideline-adherent treatment in cluster headache

Cephalalgia ◽  
2015 ◽  
Vol 36 (8) ◽  
pp. 760-764 ◽  
Author(s):  
Victoria Lademann ◽  
Jan-Peter Jansen ◽  
Stefan Evers ◽  
Achim Frese
Keyword(s):  
Cluster Headache ◽  
Acute Treatment ◽  
Prophylactic Treatment ◽  
Treatment Guidelines ◽  
Acute Attack ◽  
Chronic Cluster Headache ◽  
European Federation ◽  
Efficacy Rate ◽  
History Of ◽  
Headache Patients

Background Several treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines. Methods We enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies. Results Regarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache. Conclusion The rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficacy of this treatment is significantly higher than the efficacy of non-guideline-adherent treatment.

scholarly journals Update on Treatment of Cluster Headache

2021 ◽  
Vol 39 (3) ◽  
pp. 113-120
Author(s):  
Jong-Hee Sohn ◽  
Mi Ji Lee ◽  
Soo-Jin Cho
Keyword(s):  
Cluster Headache ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Preventive Therapy ◽  
Systemic Steroid ◽  
Novel Treatments ◽  
Primary Headache Disorder ◽  
Cranial Autonomic Symptoms ◽  
High Flow Oxygen

Cluster headache (CH) is characterized by severe unilateral short-lasting headache attacks, accompanying ipsilateral cranial autonomic symptoms or the sense of restlessness and agitation, or both. CH is a highly disabling primary headache disorder but often not optimally treated. High-flow oxygen and parenteral triptans are the most effective treatment to treat an acute CH attack. Transitional treatments include systemic steroid therapy and sub-occipital steroid injection. For preventive therapy, verapamil and lithium are recommended as first-line treatments. Novel treatments have appeared, such as neuromodulation and medication targeting calcitonin gene-related peptide (CGRP) or its receptor. Galcanezumab, the only anti-CGRP receptor monoclonal antibody with proven efficacy for the preventive treatment of episodic CH, represents an important advance for pharmacological treatment of CH. Neuromodulation strategies, such as the non-invasive vagus nerve stimulation and the sphenopalatine ganglion stimulation, have been proven effective in reducing the intensity and frequency of attacks, and also to be safe and well tolerated.

Dopaminergic system abnormalities in chronic cluster headache patients

2021 ◽  
Vol 429 ◽  
pp. 117736
Author(s):  
Luca Giani ◽  
Stefania Ferraro ◽  
Anna Nigri ◽  
Maria Grazia Bruzzone ◽  
Chiara Pinardi ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Dopaminergic System ◽  
Chronic Cluster Headache ◽  
Headache Patients

Changes in medication cost observed in chronic cluster headache patients treated with sphenopalatine ganglion (SPG) stimulation: Analysis based on 1-year data from the Pathway R-1 Registry

Cephalalgia ◽  
2018 ◽  
Vol 38 (8) ◽  
pp. 1455-1462 ◽  
Author(s):  
Jan B Pietzsch ◽  
Simon A Weber ◽  
Nunu Lund ◽  
Charly Gaul
Keyword(s):  
Cluster Headache ◽  
Cost Savings ◽  
Chronic Cluster Headache ◽  
Medication Cost ◽  
Base Case ◽  
Sphenopalatine Ganglion ◽  
Chronic Patients ◽  
Medication Costs ◽  
Preventive Medication ◽  
Headache Patients

Background On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and effective therapy for treatment-refractory cluster headache patients. Our objective was to estimate changes in cluster headache medication cost observed in SPG-treated chronic patients. Methods Detailed patient-level data of 71 chronic patients treated with the Pulsante® SPG Microstimulator System were available from the Pathway R-1 Registry through 12 months’ follow-up. We used utilization data of preventive and acute medications reported at baseline, 3, 6, 9, and 12 months to estimate annualized drug costs for SPG-treated patients and compared it to baseline. Cost estimates for all drug/dosage combinations were developed based on German medication prices for 2016. Results In the base case analysis, mean annual acute and preventive medication costs decreased from €14,178 to €6924 (−€7254; −51%), and €559 to €328 (−€231; −41%), respectively, leading to total estimated annual drug cost savings of €7484, 97% of which were attributable to acute medications. Conclusions Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in cluster headache medication usage that might lead to sizable annual savings in medication costs.

scholarly journals Acute and preventive treatment use in a phase-3 randomized trial of galcanezumab in chronic cluster headache

2019 ◽  
Vol 405 ◽  
pp. 62-63
Author(s):  
M. Lanteri-Minet ◽  
K. Kalidas ◽  
T. Oakes ◽  
J. Bardos ◽  
C. Zhou ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Randomized Trial ◽  
Preventive Treatment ◽  
Chronic Cluster Headache ◽  
Phase 3 ◽  
Treatment Use
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