J Korean Neurol Assoc.  2021 Aug;39(3):113-120. 10.17340/jkna.2021.3.1.

Update on Treatment of Cluster Headache

• Sohn JH
• Lee MJ
• Cho SJ

• KMID: 2518927
• DOI: http://doi.org/10.17340/jkna.2021.3.1

Abstract

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.

Keyword

Cluster headache; Calcitonin gene-related peptide; Trigeminal autonomic cephalalgias