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Review Article
- Update on Cluster Headaches: From Genetic to Novel Therapeutic Approaches
- Myun Kim, Je Kook Yu, Yoo Hwan Kim
- Headache Pain Res. 2024;25(1):42-53. Published online April 22, 2024
- DOI: https://doi.org/10.62087/hpr.2024.0009
- 452 View
- 13 Download
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Abstract
PDF - Cluster headaches affect 0.1% of the population and are four times more common in males than in females. Patients with this condition present with severe unilateral head pain localized in the frontotemporal lobe, accompanied by ipsilateral lacrimation, conjunctival injection, nasal congestion, diaphoresis, miosis, and eyelid edema. Recently, the first genome-wide association study of cluster headaches was conducted with the goal of aggregating data for meta-analyses, identifying genetic risk variants, and gaining biological insights. Although little is known about the pathophysiology of cluster headaches, the trigeminovascular and trigeminal autonomic reflexes and hypothalamic pathways are involved. Among anti-calcitonin gene-related peptide monoclonal antibodies, galcanezumab has been reported to be effective in preventing episodic cluster headaches.
Original Articles
- Cluster Headache Characteristics and the Severity of Obstructive Sleep Apnea: Insights from Polysomnography Analysis
- Yooha Hong, Mi-Kyoung Kang, Min Kyung Chu, Soo-Jin Cho, Hee-Jin Im
- Headache Pain Res. 2024;25(1):63-71. Published online April 16, 2024
- DOI: https://doi.org/10.62087/hpr.2024.0001
- 289 View
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Abstract
PDF
- Purpose: Cluster headache (CH) is characterized by circadian rhythmicity of the attacks, and it is known to respond exceptionally well to oxygen therapy. Furthermore, obstructive sleep apnea (OSA) frequently co-occurs with CH, and both conditions may be parallel outcomes of hypothalamic dysfunction rather than being causally related. The aim of this study was to analyze the association between CH characteristics and polysomnographic factors stratified by the severity of OSA in patients diagnosed with CH and OSA.
Methods
We retrospectively analyzed the data of OSA patients with CH who were enrolled in the Korean Cluster Headache Registry and underwent polysomnography due to clinical suspicion of OSA. Basic demographic data, headache-related parameters, and polysomnographic parameters were analyzed according to the severity of OSA (apnea-hypopnea index: <15 or ≥15 per hour).
Results
Twelve CH patients with OSA were evaluated. The onset age of CH was higher (38.5 years vs. 19.0 years, p=0.010), and the maximal duration of cluster bouts was longer (156.5 days vs. 47.0 days, p=0.037) in the moderate-to-severe OSA group than in the mild OSA group. Unlike other polysomnographic parameters, the apnea-hypopnea index and respiratory arousal index during rapid eye movement (REM) sleep were comparable across different OSA severity levels.
Conclusion
The onset age and duration of cluster bouts were associated with the severity of OSA in CH patients. Additionally, the relatively high susceptibility to hypoxia during REM sleep in patients with mild OSA implies that interventions may be potentially advantageous, even in CH patients with mild OSA.
- Secular Trend of Sex Ratio in Participants under Randomized Controlled Trials for Cluster Headache
- Pil-Wook Chung, Heui-Soo Moon
- Korean J Headache. 2023;24(2):70-76. Published online December 31, 2023
- 140 View
- 4 Download
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Abstract
PDF
- Background
Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies.
Methods
We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared.
Results
22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1st era), 8 studies from 2001 to 2010 (2nd era), 14 studies after 2010 (3rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1st era, while 83% were male in 2nd era, and 75.3% were male in 3rd era (p<0.001). Male to female ratio was 6.7:1 in 1st era, 4.9:1 in 2nd era, and 3:1 in 3rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001)
Conclusions
As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.
Review Article
- Updated Treatment of Trigeminal Autonomic Cephalalgias
- So Youn Choi, Michelle Sojung Youn, Mi Ji Lee
- Korean J Headache. 2023;24(2):45-49. Published online December 31, 2023
- 411 View
- 9 Download
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Abstract
PDF
- Trigeminal Autonomic Cephalalgia (TAC) encompasses cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks (SUNHA), and hemicrania continua. The treatment of cluster headache consists of acute therapy and preventive treatment. The available options for acute treatment in South Korea include high-flow O2 inhalation, zolmitriptan oral medication, and intranasal lidocaine spray. In the transitional phase of cluster headache, oral steroids and suboccipital steroid injections are commonly used. Verapamil and lithium have been widely used as preventive medications, but recently, galcanezumab, a monoclonal antibody targeting calcitonin gene-related peptide, has emerged as a recognized preventive treatment for cluster headache. In addition, neuromodulation techniques, such as noninvasive vagus nerve stimulation, sphenopalatine ganglion stimulation, occipital nerve stimulation, and deep brain stimulation, are also available for the treatment of cluster headache. Paroxysmal hemicrania and hemicrania continua are absolutely responsive to indomethacin; however, when indo methacin is contraindicated, alternative treatments are necessary. Reported alternatives include topiramate, vagus nerve stimulation, verapamil, and carbamazepine for paroxysmal hemicrania, and topiramate, gabapentin, and neurostimulation for hemicrania continua. Treatment options for SUNHA are limited, but short-term preventive approaches such as intravenous lidocaine, as well as the use of lamotrigine for preventive treatment, can be considered.
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