EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias

A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby

Research output: Article

264 Citations (Scopus)

Abstract

Cluster headache and the other trigeminal-autonomic cephalalgias [paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome] are rare but very disabling conditions with a major impact on the patient's quality of life. The objective of this study was to give evidence-based recommendations for the treatment of these headache disorders based on a literature search and consensus amongst a panel of experts. All available medical reference systems were screened for any kind of studies on cluster headache, paroxysmal hemicrania and SUNCT syndrome. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies resulting in level A, B or C recommendations and good practice points. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 7 l/min over 15 min and 6 mg subcutaneous sumatriptan are drugs of first choice. Prophylaxis of cluster headache should be performed with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy or tolerability). Although no class I or II trials are available, steroids are clearly effective in cluster headache. Therefore, the use of at least 100 mg methylprednisone (or equivalent corticosteroid) given orally or at up to 500 mg i.v. per day over 5 days (then tapering down) is recommended. Methysergide, lithium and topiramate are recommended as alternative treatments. Surgical procedures, although in part promising, require further scientific evaluation. For paroxysmal hemicranias, indomethacin at a daily dose of up to 225 mg is the drug of choice. For treatment of SUNCT syndrome, large series suggest that lamotrigine is the most effective preventive agent, with topiramate and gabapentin also being useful. Intravenous lidocaine may also be helpful as an acute therapy when patients are extremely distressed and disabled by frequent attacks.

Original languageEnglish
Pages (from-to)1066-1077
Number of pages12
JournalEuropean Journal of Neurology
Volume13
Issue number10
DOIs
Publication statusPublished - okt. 2006

Fingerprint

Trigeminal Autonomic Cephalalgias
Cluster Headache
SUNCT Syndrome
Guidelines
Paroxysmal Hemicrania
Sumatriptan
Therapeutics
Methysergide
Headache Disorders
Verapamil
Lidocaine
Lithium
Indomethacin
Pharmaceutical Preparations
Headache
Adrenal Cortex Hormones
Steroids
Quality of Life
Oxygen
Injections

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. / May, A.; Leone, M.; Áfra, J.; Linde, M.; Sándor, P. S.; Evers, S.; Goadsby, P. J.

In: European Journal of Neurology, Vol. 13, No. 10, 10.2006, p. 1066-1077.

Research output: Article

May, A. ; Leone, M. ; Áfra, J. ; Linde, M. ; Sándor, P. S. ; Evers, S. ; Goadsby, P. J. / EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. In: European Journal of Neurology. 2006 ; Vol. 13, No. 10. pp. 1066-1077.
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