Cluster headache therapies: pharmacology and mode of action.

Jasper Mecklenburg, Margarita Sanchez Del Rio, Uwe Reuter

Expert review of clinical pharmacology 2020 Jun

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Cluster headache (CH) is the most common trigeminal autonomic cephalalgia with a significant need for novel treatment options. While the use of most of the acute CH medications is supported by clinical trials and based on a pathophysiological concept for the generation of pain, the scientific evidence for preventive CH medications is very limited. This article reviews acute and preventive substances for the pharmacological treatment of CH with a focus on the mode of action of these drugs. We also summarized the clinical trial evidence and discuss future research directions. Recommendations for current pharmacological CH therapies, in particular for CH prevention, are often based on small open label studies with inconclusive results. Larger trials are missing. A shared pathophysiological mechanism of action of these preventatives does not exist. Future studies with CGRP(R) antibodies and novel substances with specific actions are needed and will thereby help to understanding the pathophysiology of CH.

Citation

Jasper Mecklenburg, Margarita Sanchez Del Rio, Uwe Reuter. Cluster headache therapies: pharmacology and mode of action. Expert review of clinical pharmacology. 2020 Jun;13(6):641-654