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Cluster headache: present and future therapy

  • NEW FINDINGS ABOUT THE PATHOPHYSIOLOGY AND THERAPY OF CLUSTER HEADACHE
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Abstract

Cluster headache is characterized by severe, unilateral headache attacks of orbital, supraorbital or temporal pain lasting 15–180 min accompanied by ipsilateral lacrimation, rhinorrhea and other cranial autonomic manifestations. Cluster headache attacks need fast-acting abortive agents because the pain peaks very quickly; sumatriptan injection is the gold standard acute treatment. First-line preventative drugs include verapamil and carbolithium. Other drugs demonstrated effective in open trials include topiramate, valproic acid, gabapentin and others. Steroids are very effective; local injection in the occipital area is also effective but its prolonged use needs caution. Monoclonal antibodies against calcitonin gene-related peptide are under investigation as prophylactic agents in both episodic and chronic cluster headache. A number of neurostimulation procedures including occipital nerve stimulation, vagus nerve stimulation, sphenopalatine ganglion stimulation and the more invasive hypothalamic stimulation are employed in chronic intractable cluster headache.

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Authors and Affiliations

  1. Department of Neurology and Headache Centre, Fondazione Istituto Nazionale Neurologico ‘Carlo Besta’, Via Celoria 11, 20133, Milan, Italy

    Massimo Leone, Alessandro Giustiniani & Alberto Proietti Cecchini

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  1. Massimo Leone
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  2. Alessandro Giustiniani
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  3. Alberto Proietti Cecchini
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Correspondence to Massimo Leone.

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Leone, M., Giustiniani, A. & Cecchini, A.P. Cluster headache: present and future therapy. Neurol Sci 38 (Suppl 1), 45–50 (2017). https://doi.org/10.1007/s10072-017-2924-7

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