Cluster Headache: New Therapies in the Horizon Cefaleia em Salvas: O Advento de Novas Terapêuticas

Abstract

Cluster headache (CH) is one of the most painful syndromes known to man. Its etiology is still unknown, and its pathogenesis is also not well known. The brief duration and severity of the attacks command the use of fast acting pain relievers and treatment to prevent further attacks. Oxygen inhalation and injectable sumatriptan are the most effective acute treatments. Several preventive drugs are available, but verapamil is the best one, however, the scientific evidence of the efficacy and tolerability of preventive drugs is poor, and they may become ineffective, especially in those who develop chronic cluster headache. Surgical procedures for the chronic refractory form of the disorder should then be contemplated however, the scientific evidence for its efficacy and tolerability is also poor and they have additional potentially severe risks. With the happening of monoclonal antibodies against the calcitonin gene related peptid (CGRP), that is increased during the attacks, one of them, namely galcanezumab, proved on controlled trials efficacy and tolerability to treat cluster headache, and it is a new hope for the treatment of those patients.