[Treatment and prophylaxis for cluster headaches and other trigeminal autonomic headaches. Revised recommendations of the German Migraine and Headache Society].
Following the new IHS classification, cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) are included in the classification as trigeminal autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. Clinically, this physiology predicts pain with some combination of lacrimation, conjunctival injection, nasal congestion, or eyelid edema. Broadly the management of TAC comprises acute and prophylactic treatment. Some types of trigeminal autonomic headaches such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indomethacin, leading to a consideration of indomethacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence-based medicine (EBM) are rare, most patients can be treated sufficiently.
May
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A
Neurologische Universitätsklinik Regensburg. a.may@uke.uni-hamburg.de
Evers
S
S
Straube
A
A
Pfaffenrath
V
V
Diener
H C
HC
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D001342:Autonomic Nervous System Diseases / Q000145:classification / Q000188:drug therapy*; D003027:Cluster Headache / Q000145:classification / Q000188:drug therapy*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D020773:Headache Disorders / Q000145:classification / Q000188:drug therapy*; D006801:Humans; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000145:classification / Q000188:drug therapy*
D000700:Analgesics