Updated EAN guidelines for the prevention and treatment of cluster headache
Mona Nada, MBBCh, MD, Cairo University, Cairo, Egypt, comments on the new guidelines from the European Academy of Neurology (EAN) for the treatment and prevention of cluster headache. Dr Nada mentions the use of anti-CGRP antibodies, oxygen therapy, triptans administered intranasally or subcutaneously, and calcium channel blockers, while cautioning against the use of oral triptans and non-steroidal anti-inflammatory drugs. This interview was recorded via an online conference call with The Video Journal of Neurology (VJNeurology).
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Transcript
We have these new guidelines from the European Academy of Neurology that published the guidelines describing the new advances in the pathogenesis and the updates of the treatment. We have the new lines for treating cluster headache, like the involvement of the anti-CGRP antibodies and this is, I think, the new era in the treatment of headache in general and specifically in migraine and cluster headache...
We have these new guidelines from the European Academy of Neurology that published the guidelines describing the new advances in the pathogenesis and the updates of the treatment. We have the new lines for treating cluster headache, like the involvement of the anti-CGRP antibodies and this is, I think, the new era in the treatment of headache in general and specifically in migraine and cluster headache. Following these guidelines, we can know which proper abortive treatment that we can use in cluster headache because this carries the misjudgment sometimes of using the oral triptans, which will have this very short headache with a very long-acting effect, so we usually use as an abortive treatment either the oxygen mask with a specific characteristic that it’s 100% oxygen with a non-rebreathable mask for 15 minutes, and we can use the triptans, but we can use the triptans using the intranasal or the subcutaneous route, because, as I mentioned, it’s a very short duration of the headache, so the oral route is not used in cluster headache. Also, non-steroidals don’t have a role and this sometimes adds to the medication overuse and the gastritis and the side effects from the non-steroidal anti-inflammatory drugs, which will not add benefit for our patients. The other part of the guidelines is the prevention. We usually say that if we can prevent this headache, this debilitating headache, this is a great success because we have the two types of cluster headache, whether this is an episodic type that happens in a part of the year and we have more than three months between the episodes and the other attack, and there is a remission period of more than three months, or the unlikely scenario that the patient has the chronic cluster headache, which is a very severe attack that has no remissions in between or very short remissions. So the prophylactic treatment is very important in dealing with such patients. We can use the calcium channel blockers, verapamil, topiramate, melatonin, the anti-CGRPs can be used. And these very strict guidelines will help us to alleviate the suffering of the patient and have a very clear and proper evidence-based medicine used drugs for those patients.
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