Future treatments for cluster headache

摘要

For the acute treatment of cluster headache attacks, two novel principles appeared during the 1990s. Breathing pure oxygen helps many patients but is impractical outside of the patient's own home, and the 5-HTj receptor agonist sumatriptan given by autoinjector almost revolutionized the treatment, but is very expensive. A number of patients remain who do not respond or cannot take sumatriptan because of side-effects. Thus, there is still an unmet need for better treatments for acute attacks, but much less so than 10 years ago. In the prophylactic treatment of cluster headache verapamil has been the only significant addition during the last decade. Like other treatments of cluster headache it was introduced and brought into wide usage in the absence of good controlled trials. Recently, however, such a trial has documented the efficacy of verapamil. Although verapamil is a useful drug, it certainly does not alleviate the need for better prophylaxis of cluster headache. There are no good data describing the proportion of patients who cannot be satisfactorily treated, but a rough estimate would be a third of patients with episodic cluster headache and at least half of all patients with chronic cluster headache.