Diagnosis, pathophysiology, and management of cluster headache

TY - JOUR

T1 - Diagnosis, pathophysiology, and management of cluster headache

AU - Hoffmann, Jan

AU - May, Arne

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/1

Y1 - 2018/1

N2 - Cluster headache is a trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient's quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. The hypothalamus appears to play a fundamental role in the generation of a permissive state that allows the initiation of an episode, whereas the attacks are likely to require the involvement of the peripheral nervous system. Triptans are the most effective drugs to treat an acute cluster headache attack. Monoclonal antibodies against calcitonin gene-related peptide, a crucial neurotransmitter of the trigeminal system, are under investigation for the preventive treatment of cluster headache. These studies will increase our understanding of the disorder and perhaps reveal other therapeutic targets.

AB - Cluster headache is a trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient's quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. The hypothalamus appears to play a fundamental role in the generation of a permissive state that allows the initiation of an episode, whereas the attacks are likely to require the involvement of the peripheral nervous system. Triptans are the most effective drugs to treat an acute cluster headache attack. Monoclonal antibodies against calcitonin gene-related peptide, a crucial neurotransmitter of the trigeminal system, are under investigation for the preventive treatment of cluster headache. These studies will increase our understanding of the disorder and perhaps reveal other therapeutic targets.

KW - Anesthetics, Local

KW - Cluster Headache

KW - Humans

KW - Lidocaine

KW - Oxygen

KW - Tryptamines

KW - Journal Article

KW - Review

U2 - 10.1016/S1474-4422(17)30405-2

DO - 10.1016/S1474-4422(17)30405-2

M3 - SCORING: Review article

C2 - 29174963

VL - 17

SP - 75

EP - 83

JO - LANCET NEUROL

JF - LANCET NEUROL

SN - 1474-4422

IS - 1

ER -