Acute, transitional and long-term cluster headache treatment: pharmacokinetic issues.
BACKGROUND
The cornerstones of cluster headache therapy are based on the tripod of acute, transitional and preventative treatments that respectively aim to the control of the bouts, the transitional suppression of the relapse and the prevention of the entire cluster period. Particularly in chronic cluster headache, where a long-term preventative therapy is necessary, multiple drug regimens increase the risk of drug-drug interactions leading to variability in the clinical efficacy and to potentially harmful adverse effects.


METHODS
We focused on how clinically significant pharmacokinetic drug-drug and food-drug interactions can be carefully managed both in cluster headache patients with a progressive frequency of bouts and in chronic cluster headache sufferers. In fact, in these cases a long-term preventive therapy is indicated, increasing the possibility of interactions both with other transitional and acute cluster headache medications and with other foods or xenobiotics.


CONCLUSIONS
Pharmacokinetic interactions for both preventive, transitional and acute drugs are significant with a number of xenobiotics and other medications. Therefore, the pharmacokinetic issues knowledge is advisable for a safe and effective cluster headache management.
a CICAB Clinical Research Centre , Extremadura University Hospital and Medical School , Badajoz , Spain.
Fernando
F
de Andrés
b Advanced Molecular Diagnostics Unit , IDI-IRCCS , Rome , Italy.
Luana
L
Lionetto
c Department of Molecular Medicine, Sant'Andrea Medical Center , Sapienza University of Rome , Rome , Italy.|d Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy.|e Department of Psychiatry , Harvard Medical School , Boston , MA , USA.
Martina
M
Curto
f NESMOS Department , Sapienza University of Rome , Rome , Italy.
Matilde
M
Capi
f NESMOS Department , Sapienza University of Rome , Rome , Italy.
Fabiola
F
Cipolla
c Department of Molecular Medicine, Sant'Andrea Medical Center , Sapienza University of Rome , Rome , Italy.|d Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy.
Andrea
A
Negro
c Department of Molecular Medicine, Sant'Andrea Medical Center , Sapienza University of Rome , Rome , Italy.|d Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy.
Paolo
P
Martelletti
D000208:Acute Disease; D002908:Chronic Disease; D003027:Cluster Headache / Q000188:drug therapy* / Q000517:prevention & control; D004347:Drug Interactions; D018565:Food-Drug Interactions; D006801:Humans; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D015262:Xenobiotics / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
D015262:Xenobiotics
Pharmacokinetics; acute treatment; cluster headache; drug-drug interactions; drug-food interactions; long-term treatment; transitional therapy