-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*For medical professionals only
Cluster headache (CH) is often clinically manifested as severe pain in the orbital, supraorbital, and/or temporal region of the strict unilateral orbit, supraorbital, and/or temporal region, accompanied by autonomic symptoms on the painful side and/or restlessness and agitation, also known as "suicidal headache"
due to the severity of pain at the time of its attack.
This kind of headache generally occurs at the same time every day, and can occur multiple times in 1 day, each episode lasts between 15 minutes and 3 hours, and the onset period can last for weeks or even months
.
CH is easy to be complicated by anxiety, depression and aggressive behavior, and can also be complicated by cardiovascular disease and suicidal tendencies, which brings great pain
to patients.
This article summarizes the treatment of CH based on the first edition of the Guidelines for the Diagnosis and Treatment of Cluster Headache in China [1] and recent treatment progress at home and abroad for the reference
of clinicians and patients.
There are generally three types of drug treatment for CH: acute treatment, preventive treatment, and transitional treatment
.
is to quickly relieve headache and terminate acute headache attacks
as soon as possible.
。 It mainly includes sumatriptan, zomitriptan, rizatriptan, naratriptan, amotriptan, flotriptan, etc
.
Among them, sumatriptan and zomitriptan are commonly used in the acute phase of CH treatment
.
(1) Sumaptan: It is the most commonly used drug for the treatment of CH in clinical practice, and can achieve the purpose of treatment by rapidly expanding the intracranial blood vessels of
patients.
Sumatriptan is available orally (tablets, immediate-release), injections (subcutaneously), nasal sprays, and suppositories
.
Guidelines [1] recommend subcutaneous injection of sumatriptan 6 mg for acute onset of CH, with a headache relief rate of 75% within 15 minutes, and complete headache relief within 15 minutes in about one-third of patients
.
Sumaptan monotherapy is clinically effective as 70 percent [3].
However, there are many disadvantages of single medication, such as long course of disease, slow onset, and possible drug dependence [4], so combination therapy has gradually become an important solution for the treatment of CH [5].
Numerous clinical studies [6-8] have shown that sumatriptan combined with flunarizine is significantly more effective in headache treatment than monotherapy, the pain visual analogue score (VAS) score is significantly reduced, and the patient satisfaction is higher (P<0.
05),</b117> ( has nasal sprays (5 mg and 10 mg the drug has high lipophilicity, can penetrate the blood-brain barrier, high bioavailability, oral onset of action in 40-60 minutes,
should be preferred in the acute phase of pregnant and lactating patients.
), 10% lidocaine can be used nasally [10], which is safer, and other adverse reactions have not been reported
except for possible nasal mucosal discomfort.
However, there are currently few relevant studies, there is a lack of randomized controlled studies, and there is insufficient
evidence-based evidence.
It may be used in patients who do not respond to or are intolerant to 5-HT1B/1D receptor agonists and oxygen
.
The goal of preventive treatment is to reduce the frequency of headache attacks during the cluster period, reduce the severity of attacks, and improve the efficacy
of acute treatment.
Indications are: severe impairment of the patient's quality of life, work or school; frequent headache attacks during clusters; Acute phase medical therapy is ineffective or intolerable
.
by headache experts worldwide.
In the Swedish biological database, approximately 34% of CH patients are treated with verapamil prophylaxis during treatment [13].
Verapamil mainly prevents the occurrence of CH by affecting the release of inflammatory neuropeptides, affecting the function of the hypothalamus, blocking calcium channels, and affecting the level of inflammatory factors such as NO [14].
Verapamil 360 mg has been shown to be effective in reducing the frequency of daily attacks, with a maximum therapeutic dose of 960 mg per day [15], with optimal efficacy
achieved two to three weeks after administration.
Clinical studies have shown [16] that verapamil combined with prednisone can prophylactically treat CH and significantly reduce the duration of the cluster phase and the frequency of pain attacks, improve clinical symptoms in patients, and have a good safety profile and better results than verapamil
alone.
The incidence of heart block due to verapamil is relatively high, and an ECG should be performed before and after increasing the dose during treatment, and heart rate and blood pressure
should be closely monitored during medication.
However, long-term use can lead to renal insufficiency and hypothyroidism
.
of melatonin therapy.
However, there are certain contradictions in the relevant research results, which have yet to be verified by research
.
.
, is indicated for patients with frequent episodes of headaches ≥ 2 times a day, and the treatment period usually lasts no more than 2 weeks
.
Medications are mainly suboccipital or oral tablets of corticosteroids
.
Upper occipital nerve blocks can be combined with or without local anesthetics; Adverse reactions are mainly pain
at the injection site.
Oral administration is only recommended for short-term use, such as oral prednisone 1mg/kg per day, gradually reduced after 3~5 days or oral prednisone starting dose of 100mg per day, 5 consecutive days, 20mg every 3 days, while gradually adding verapamil prophylactic therapy [18].
of CH in children have shown that mask oxygen is effective in children with CH without significant adverse effects, and subcutaneous injection of sumaprtan is also effective [19].
It has been suggested that delivering oxygen (100%) at a flow rate of 12 L/min at the onset of CH is effective in relieving headache [20].
Oxygen therapy may be limited
due to difficulties in obtaining oxygen at all times in the home environment.
It has also been suggested that the use of sumatriptan nasal spray instillation into the ipsilateral nostril may relieve CH in children [20].
Although the mechanism of steroid action is unclear, cortisone in the acute phase is thought to slow episodes of CH in children and prevent recurrence [21].
, and the U.
S.
Food and Drug Administration (FDA).
The drug galcanezumab-gnlm was approved on June 4, 2019 for the treatment of episodic CH in adults, which is effective in reducing the frequency of
CH episodes.
This is the first drug
officially approved by the FDA for the treatment of episodic CH.
The drug is an injection that can be injected by the patient himself
.
The most common toxic side effect of the drug is a reaction at the injection site, in addition, the drug carries a certain risk of causing allergic reactions [22].
Where to see more neurological knowledge?
Come to the "doctor's station" and take a look 👇
These 5 things to know!
Cluster headache (CH) is often clinically manifested as severe pain in the orbital, supraorbital, and/or temporal region of the strict unilateral orbit, supraorbital, and/or temporal region, accompanied by autonomic symptoms on the painful side and/or restlessness and agitation, also known as "suicidal headache"
due to the severity of pain at the time of its attack.
This kind of headache generally occurs at the same time every day, and can occur multiple times in 1 day, each episode lasts between 15 minutes and 3 hours, and the onset period can last for weeks or even months
.
CH is easy to be complicated by anxiety, depression and aggressive behavior, and can also be complicated by cardiovascular disease and suicidal tendencies, which brings great pain
to patients.
This article summarizes the treatment of CH based on the first edition of the Guidelines for the Diagnosis and Treatment of Cluster Headache in China [1] and recent treatment progress at home and abroad for the reference
of clinicians and patients.
There are generally three types of drug treatment for CH: acute treatment, preventive treatment, and transitional treatment
.
One
The purpose of acute treatmentis to quickly relieve headache and terminate acute headache attacks
as soon as possible.
01 Triptans
。 It mainly includes sumatriptan, zomitriptan, rizatriptan, naratriptan, amotriptan, flotriptan, etc
.
Among them, sumatriptan and zomitriptan are commonly used in the acute phase of CH treatment
.
(1) Sumaptan: It is the most commonly used drug for the treatment of CH in clinical practice, and can achieve the purpose of treatment by rapidly expanding the intracranial blood vessels of
patients.
Sumatriptan is available orally (tablets, immediate-release), injections (subcutaneously), nasal sprays, and suppositories
.
Guidelines [1] recommend subcutaneous injection of sumatriptan 6 mg for acute onset of CH, with a headache relief rate of 75% within 15 minutes, and complete headache relief within 15 minutes in about one-third of patients
.
Sumaptan monotherapy is clinically effective as 70 percent [3].
However, there are many disadvantages of single medication, such as long course of disease, slow onset, and possible drug dependence [4], so combination therapy has gradually become an important solution for the treatment of CH [5].
Numerous clinical studies [6-8] have shown that sumatriptan combined with flunarizine is significantly more effective in headache treatment than monotherapy, the pain visual analogue score (VAS) score is significantly reduced, and the patient satisfaction is higher (P<0.
05),</b117> ( has nasal sprays (5 mg and 10 mg the drug has high lipophilicity, can penetrate the blood-brain barrier, high bioavailability, oral onset of action in 40-60 minutes,
02 Oxygen
should be preferred in the acute phase of pregnant and lactating patients.
03 Lidocaine
), 10% lidocaine can be used nasally [10], which is safer, and other adverse reactions have not been reported
except for possible nasal mucosal discomfort.
However, there are currently few relevant studies, there is a lack of randomized controlled studies, and there is insufficient
evidence-based evidence.
04 Somatostatin and its analogues
It may be used in patients who do not respond to or are intolerant to 5-HT1B/1D receptor agonists and oxygen
.
Two
Prophylactic therapyThe goal of preventive treatment is to reduce the frequency of headache attacks during the cluster period, reduce the severity of attacks, and improve the efficacy
of acute treatment.
Indications are: severe impairment of the patient's quality of life, work or school; frequent headache attacks during clusters; Acute phase medical therapy is ineffective or intolerable
.
01 Velapami
by headache experts worldwide.
In the Swedish biological database, approximately 34% of CH patients are treated with verapamil prophylaxis during treatment [13].
Verapamil mainly prevents the occurrence of CH by affecting the release of inflammatory neuropeptides, affecting the function of the hypothalamus, blocking calcium channels, and affecting the level of inflammatory factors such as NO [14].
Verapamil 360 mg has been shown to be effective in reducing the frequency of daily attacks, with a maximum therapeutic dose of 960 mg per day [15], with optimal efficacy
achieved two to three weeks after administration.
Clinical studies have shown [16] that verapamil combined with prednisone can prophylactically treat CH and significantly reduce the duration of the cluster phase and the frequency of pain attacks, improve clinical symptoms in patients, and have a good safety profile and better results than verapamil
alone.
The incidence of heart block due to verapamil is relatively high, and an ECG should be performed before and after increasing the dose during treatment, and heart rate and blood pressure
should be closely monitored during medication.
02 lithium salt
However, long-term use can lead to renal insufficiency and hypothyroidism
.
03 Melatonin
of melatonin therapy.
However, there are certain contradictions in the relevant research results, which have yet to be verified by research
.
04 Other drugs
.
Three
Transitional therapy, also known as short-term prophylactic therapy, is indicated for patients with frequent episodes of headaches ≥ 2 times a day, and the treatment period usually lasts no more than 2 weeks
.
Medications are mainly suboccipital or oral tablets of corticosteroids
.
Upper occipital nerve blocks can be combined with or without local anesthetics; Adverse reactions are mainly pain
at the injection site.
Oral administration is only recommended for short-term use, such as oral prednisone 1mg/kg per day, gradually reduced after 3~5 days or oral prednisone starting dose of 100mg per day, 5 consecutive days, 20mg every 3 days, while gradually adding verapamil prophylactic therapy [18].
Four
Studies of the treatmentof CH in children have shown that mask oxygen is effective in children with CH without significant adverse effects, and subcutaneous injection of sumaprtan is also effective [19].
It has been suggested that delivering oxygen (100%) at a flow rate of 12 L/min at the onset of CH is effective in relieving headache [20].
Oxygen therapy may be limited
due to difficulties in obtaining oxygen at all times in the home environment.
It has also been suggested that the use of sumatriptan nasal spray instillation into the ipsilateral nostril may relieve CH in children [20].
Although the mechanism of steroid action is unclear, cortisone in the acute phase is thought to slow episodes of CH in children and prevent recurrence [21].
Five
The FDA's first new drug for the treatment of episodic CH is galcanezumab-gnlm, and the U.
S.
Food and Drug Administration (FDA).
The drug galcanezumab-gnlm was approved on June 4, 2019 for the treatment of episodic CH in adults, which is effective in reducing the frequency of
CH episodes.
This is the first drug
officially approved by the FDA for the treatment of episodic CH.
The drug is an injection that can be injected by the patient himself
.
The most common toxic side effect of the drug is a reaction at the injection site, in addition, the drug carries a certain risk of causing allergic reactions [22].
References:
[1] Pain and Sensory Disorders Group, Neurologist Branch of Chinese Medical Doctor Association, Headache and Sensory Disorders Special Committee of China Research Hospital Association.
Guidelines for the diagnosis and treatment of cluster headache in China[J].
Chinese Journal of Pain Medicine,2022,28(9):641-653.
)
[2] LIU Wei, YAN Manyun.
Mechanism of triptan therapy for cluster headache[J].
Chinese Journal of Clinical Neuroscience,2019,27(6):705-708,714.
)
[3] Xu Meng.
Therapeutic effect of sumatriptan combined with flunarizine on cluster headache[J].
Henan Medical Research,2018,27(2):308-309.
)
[4] Leng Xiangong.
Clinical effect evaluation of flunarizine hydrochloride combined with aspirin in the treatment of migraine[J].
Health Vision,2020,(20):32.
)
[5] YU Lei, ZHENG Wenxu.
Effect of flunarizine hydrochloride prophylactic treatment on the efficacy and safety of migraine patients[J].
Chinese Medical Guide,2020,18(22):107-108,113.
)
[6] Ming Xiaoxing.
Clinical treatment effect of sumatriptan combined with flunarizine in cluster headache[J].
World Latest Medical Information Abstracts (Continuous Electronic Journal),2020,20(A4):251-252.
)
[7] ZHANG Xuerong.
Effect of sumatriptan combined with flunarizine in the treatment of cluster headache[J].
Henan Medical Research,2018,27(3):496-497.
)
[8] Bell ringing.
Observation of the therapeutic effect of sumatriptan combined with flunarizine on cluster headache[J].
Modern Chinese Drug Application,2020,14(1):114-115.
)
[9] Wei Liu (Supervisor Zhao Hongru).
Efficacy and safety of oral zomitriptan treatment in the prodromal stage of cluster headache attack[J].
Clinical Medical Neurology, Soochow University (Master's Thesis), 2021.
[10] Liang JF，Chen YT，Fuh JL，et al.
Cluster headache is associated with an increased risk of depression：a nationwide population-based cohort study[J].
Cephalalgia，2013，33：182-189.
[11] Matharu MS，Levy MJ，Meeran K，et al.
Subcutaneous octreotide in cluster headache：randomized placebocontrolled double-blind crossover study[J].
Annals Neurol，2004，56（4）：488-494.
[12] ROBBINS M S，STARLING A J，PRINGSHEIM T M，et al.
Treatment of Cluster Headache：The American Headache Society Evidence-Based Guidelines[J].
Headache，2016，56（7）：1093-1106.
[13] STEINBERG A，FOURIER C，RAN C，et al.
Cluster headache-clinical pattern and a new severity scale in a Swedish cohort[J].
Cephalalgia，2018，38（7）：1286-1295.
[14] PENG Zhongxing, WANG Yaochen.
Research progress on the mechanism of verapamil in the treatment of cluster headache[J].
Journal of Southeast University(Medical Sciences),2020,39(4):538-542.
)
[15] May A，Schwedt TJ，Magis D，et al.
Cluster headache[J].
Nat Rev Dis Primers，2018，4：18006.
[16] Menshuang.
Clinical observation of verapamil combined with prednisone in the preventive treatment of cluster headache[J].
International Medical and Health Herald,2022,28(2):176-179.
)
[17] May A，Leone M，Afra J，et al.
EFNS guidelines on the treatment of cluster headache and other trigeminalautonomic cephalalgias[J].
Eur J Neurol，2006，13（10）：1066-1077.
[18] Obermann M，Nägel S，Ose C，et al.
Safety and efficacy of prednisone versus placebo in shortterm prevention of episodic cluster headache：a multicentre，double-blind，randomised controlled trial[J].
Lancet Neurol，2021，20（1）：29-37.
[19] Alfaro-Iznaola C，Natera-de Benito D，Rodriguez-Diaz R，et al.
Cluster headache in pediatric population：four case reports and review of the literature［J］.
Rev Neurol，2016，63（2）：65-70.
[20] Mack KJ，Goadsby P.
Trigeminal autonomic cephalalgias in children and adolescents：cluster headache and related conditions［J］.
Semin Pediatr Neurol，2016，23（1）：23-26.
doi：10.
1016/ j.
spen.
2015.
08.
002.
[21] Mariani R，Capuano A，Torriero R，et al.
Cluster headache in childhood：case series from a pediatric headache center[J].
J Child Neurol，2014，29（1）：62-65.
doi：10.
1177/0883073812470735.
[22] Xia Xunming, ed.
The US FDA approved the first episodic cluster headache treatment drug Emgality (galcanezumab-gnlm)[J].
Journal of Guangdong Pharmaceutical University,2019,35(3):336.
)
Where to see more neurological knowledge?
Come to the "doctor's station" and take a look 👇
