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Cluster Headache is Still Lurking in the Shadows
Paolo Martelletti1,2, Martina Curto3,4,5
1Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. paolo.martelletti@uniroma1.it.
Pain and Therapy
|June 6, 2021
Summary
Cluster headache diagnosis is delayed by 60 months due to physician unawareness. New CGRP monoclonal antibodies offer hope but face access challenges, potentially worsening cluster headache progression.
Area of Science:
- Neurology
- Pain Medicine
Background:
- Cluster headache is characterized by severe, episodic head pain.
- Diagnosis is significantly delayed, averaging 60 months.
- Lack of awareness among non-specialist physicians contributes to diagnostic delays.
Purpose of the Study:
- To highlight the diagnostic delay in cluster headache.
- To discuss the limitations of older treatments.
- To examine the potential and challenges of new CGRP-targeted therapies.
Main Methods:
- Review of clinical manifestations and diagnostic pathways for cluster headache.
- Analysis of treatment efficacy and adverse events of older drugs.
- Assessment of emerging monoclonal antibody therapies targeting calcitonin gene-related peptide (CGRP) and its receptor (CGRP(r)).
Main Results:
- Despite dramatic symptoms, cluster headache diagnosis is delayed due to insufficient physician education.
- Traditional cluster headache treatments have high efficacy but significant adverse events.
- New CGRP-targeted therapies show promise, mirroring their success in migraine treatment.
Conclusions:
- Improved education for emergency physicians and specialists is crucial to reduce cluster headache diagnostic delays.
- Limited global access to CGRP monoclonal antibodies may impede effective management.
- Inadequate access to novel therapies could accelerate the progression from episodic to chronic and refractory cluster headache.
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