Pharmacotherapy options for cluster headache.
BACKGROUND
Cluster headache (CH) is a primary headache disorder and the most common trigeminal autonomic cephalalgia. Patients suffer from very severe unilateral headache attacks accompanied by ipsilateral trigeminal autonomic symptoms. Previous studies described a high burden of disease due to its impact on social life as well as an increased suicide ideation rate. The mean time to diagnosis in western industrialized countries is estimated at 4 years.


METHODS
Many treatment options for CH exist, but due to the rarity of the disease, controlled randomized clinical studies remain difficult to perform. This review summarizes the current knowledge about the treatment of CH including internationally accepted treatment guidelines, and an additional MEDLINE search (1 February 2015).


CONCLUSIONS
International treatment recommendations and official guidelines give reassurance about specific pharmacotherapy options for CH, but only few of these are backed by sufficient scientific evidence. The limited therapeutic efficacy in some patients leads to the use of alternative, complementary, but also illicit drugs to better cope with the disease. Many single cases, case series and uncontrolled studies were performed with different substances in an attempt to find a better way to treat or prevent the excruciatingly painful attacks associated with CH. Large-scale, randomized controlled clinical trials are desperately needed in order to further increase the quality of patient care for this outstanding but terrifying disease.
University of Duisburg-Essen, Department of Neurology , Hufelandstr. 55, 45122 Essen , Germany +49 201 723 84385 ; +49 201 723 5542 ; mark.obermann@uni-due.de.
Mark
M
Obermann
Dagny
D
Holle
Steffen
S
Naegel
Jan
J
Burmeister
Hans-Christoph
HC
Diener
D003027:Cluster Headache / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic
cluster headache; current treatment; future treatment; pharmacotherapy; treatment options