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Trying to Tame the Cluster Headache Beast

We should take our hats off to the people diagnosed with cluster headache. Not only do they experience pain so excruciating that their condition has earned a reputation as being the most painful disorder known to mankind, but the lack of effective treatments means little can be done to relieve each agonizing episode.

Cluster headaches typically begin around the eye socket or temple and come on quickly and fiercely, reaching their full intensity within 5 to 10 minutes and staying at that tortuous level for up to three hours, sometimes longer, before abruptly stopping. They usually begin at the same time of year, at the same time each day, and can recur as often as eight times in one day.

Episodic cluster headaches (ECH) are the most prevalent, and characterized by bouts lasting more than one week, with at least a month’s relief between clusters. Chronic cluster headaches (CCH) fail to let up at all and are defined by the absence of a remission period longer than one month.

To add to the unfairness of it all, treatment is challenging. Sumatriptan injections and oxygen therapy have proven to be the most effective acute agents but finding a good preventive agent to reduce the frequency of attacks per cluster is difficult. Many preventive agents have troublesome side effects which can be particularly noticeable in people with CCH who must take them on a daily basis.

But there is hope on the horizon in the form of Emgality, recently approved for migraine and granted breakthrough therapy designation status for cluster headaches by the FDA in November 2018. Emgality works by inhibiting the actions of CGRP, a small protein involved in pain transmission that may also play a role in initiating headache attacks. It was the third anti-CGRP treatment to gain approval in 2018, but the only one that looks promising for cluster headaches. But the news is bittersweet, as trials support its use in ECH, not CCH. If further research is positive, then an approval can be expected sometime in 2019.

For more information about Emgality, see here.

Posted: January 2019

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