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European Academy of Neurology guidelines on the treatment of cluster headache |
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| Authors: | Arne May Stefan Evers Peter J. Goadsby Massimo Leone Gian Camillo Manzoni Julio Pascual Vanessa Carvalho Michele Romoli Katina Aleksovska Patricia Pozo-Rosich Rigmor H. Jensen European Academy of Neurology Task Force |
| Affiliation: | 1. Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany;2. Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany Faculty of Medicine, University of Münster, Münster, Germany;3. NIHR King's CRF, SLaM Biomedical Research Centre, King's College London, London, UK;4. Neuroalgology Department, Foundation of the Carlo Besta Neurological Institute, IRCCS, Milan, Italy;5. Department of Neurology, Università degli Studi di Parma, Parma, Italy;6. Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Santander, Spain;7. Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal;8. Neurology and Stroke Unit, Bufalini Hospital, Cesena, Italy;9. European Academy of Neurology;10. Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain;11. Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark |
| Abstract: | Background and PurposeCluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts.MethodsThe databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).RecommendationsFor the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile. |
| Keywords: | cluster headache guideline TAC treatment trigeminal autonomic cephalalgia |