Rigmor Hojland Jensen, MD, from University of Copenhagen, Glostrup, Denmark, discusses the new clinical guidelines for cluster headache treatment and the difficulties associated with their development. The new European Academy of Neurology guidelines on the treatment of cluster headache, published in October 2023, are based on existing evidence gathered over the last 20 years of research, although this is still a field of research that needs significant development. Primary recommendations for acute cluster headache treatment are the use of 100% oxygen with a flow of at least 12 L/min over 15 min and 6mg subcutaneous sumatriptan or intranasal zolmitriptan. The use of oral agents as treatments for acute cluster headache has proved ineffective due to slow uptake being impractical for the short-lasting attacks. Verapamil is recommended as a preventive treatment in cluster headache, based on strong efficacy evidence. Corticosteroids can be used as a transitional therapy or an additive while waiting for verapamil to take effect. The use of corticosteroids in chronic cluster headache is limited by the development of severe side effects.
This interview took place at the World Congress of Neurology (WCN) 2023 in Montreal, Canada.
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