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European Academy of Neurology guidelines on the treatment of cluster headache

Abstract: Background and purpose: Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts. Methods: The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Recommendations: For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.

 Fuente: European Journal of Neurology, 2023, 30, 2955-2979

Editorial: Wiley

 Año de publicación: 2023

Nº de páginas: 25

Tipo de publicación: Artículo de Revista

 DOI: 10.1111/ene.15956

ISSN: 1351-5101,1468-1331

Url de la publicación: https://doi.org/10.1111/ene.15956

Autores/as

MAY, ARNE

EVERS, STEFAN

GOADSBY, PETER J.

LEONE, MASSIMO

MANZONI, GIAN CAMILLO

CARVALHO, VANESSA

ROMOLI, MICHELE

ALEKSOVSKA, KATINA

POZO-ROSICH, PATRICIA

JENSEN, RIGMOR H.