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World neurology updates: Other primary headache disorder - Treatment
Sina Marzoughi1, Peter J Goadsby1,2
1NIHR King's Clinical Research Facility and Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
Abstract:
•The trigeminal autonomic cephalalgias are a severe disabling form of primary headache disorders characterized by severe unilateral pain commonly associated with ipsilateral cranial autonomic features as well as a sense of restlessness or agitation, of which the most common is cluster headache.•Different forms of trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania (PH), hemicrania continua (HC), short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) and are differentiated based on their duration and frequency•Triptans, such as sumatriptan by injection, high flow 100 % oxygen by face mask, or non-invasive vagus nerve stimulation, are mainstay acute treatments of attacks of cluster headache.•Interim preventive treatments to reduce attack frequency include a short course of high dose oral corticosteroids, local anesthetic/corticosteroid injection around the homolateral (to pain) greater occipital nerve or the CGRP monoclonal antibody galcanezumab.•Verapamil is considered the mainstay medium to long-term preventive with additional options being lithium, melatonin, topiramate, or non-invasive and invasive neuromodulation.
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