Recently available and emerging therapeutic strategies for the acute and prophylactic management of cluster headache: a systematic review and expert opinion

ABSTRACT

Introduction: Although it causes a huge burden to sufferers, cluster headache (CH), remains an undertreated condition, partly due to the absence of established acute and prophylactic treatment options. New therapeutic approaches providing fast and safe relief from CH are needed.

Areas covered: A systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation on recently published (last 5 years) papers on CH treatment. The authors also collected preliminary results from ongoing trials on emerging therapeutic/preventive pharmacological and interventional approaches for CH. Studies and results are reviewed and discussed.

Expert opinion: The complexity of CH pathophysiology prevents the definition of reliable acute and preventive treatments. In the real-world clinical setting, several treatments are combined to provide relief to patients and increase their quality of life. Drugs targeting neuropeptides or their receptors within the trigeminovascular network are of particular interest to prevent CH attacks. Calcitonin gene-related peptide (CGRP) blockade seems attractive and promising, but studies on anti-CGRP monoclonal antibodies indicated rather modest or even absence of a prophylactic effect. A deeper insight into CH pathophysiology, and combined approaches may lead the path to new, more effective, and personalized CH therapies.

KEYWORDS:

• Cluster headache
• episodic cluster headache
• chronic cluster headache
• neuropeptides
• calcitonin gene-related peptide
• acute/abortive treatment
• prevention/prophylaxis

Article highlights

• Cluster headache is the most disabling primary headache disorder.

• There are significant unmet treatment options needs for cluster headache patients.

• One hundred percent oxygen inhalation is the best available option for the acute treatment of cluster headache.

• Available preventive pharmacological treatments are unspecific and hampered by side-effects.

• Drugs targeting neuropeptides or their receptors within the trigeminovascular system are of theoretical interest to prevent cluster headache attacks.

• Calcitonin-gene-related neuropeptide blockade appeared to be an attractive preventive option for cluster headache, but the available evidence is rather modest.

• Further pathophysiological insight may lead the path to new and more specific therapies for cluster headache.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.