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Chronic Cluster Headache Update and East–West Comparisons: Focusing on Clinical Features, Pathophysiology, and Management

  • Chronic Daily Headache (SJ Wang, Section Editor)
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Abstract

Purpose of Review

This review provides an update on chronic cluster headache (CH) focusing on clinical features, pathophysiology, and management as well as comparisons between Eastern and Western populations.

Recent Findings

Chronic CH in Eastern populations was relatively rare, compared to that in Western populations. Lacrimation and/or conjunctival injection is the most frequently reported cranial autonomic symptom, and visual aura is predominant in chronic CH patients. Neuroimaging evidence in both ethnic groups suggests that CH pathophysiology involves the hypothalamus and pain-modulatory areas, with dynamic alternations between CH episodes. Recent evidence indicates that midbrain dopaminergic systems may participate in CH chronicity. Noteworthy advances have emerged in neuromodulatory therapies for chronic CH, but treatment with calcitonin gene-related peptide (CGRP) monoclonal antibodies has been unsuccessful.

Summary

Recent evidence shows divergence of chronic CH between Eastern and Western populations. Neuromodulatory therapies but not CGRP inhibition is effective in this intractable patient group.

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Funding

This project was supported in part by grants from the Ministry of Science and Technology of Taiwan (MOST 108-2314-B-016-023-) and TSGH (TSGH-C108-100, TSGH-D-109101, TSGH-D-109185).

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Authors and Affiliations

  1. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Chia-Lin Tsai, Guan-Yu Lin & Fu-Chi Yang

  2. Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada

    Sheng-Kai Wu

  3. Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada

    Sheng-Kai Wu

  4. Brain Research Center, National Yang-Ming University, Taipei, Taiwan

    Shuu-Jiun Wang

  5. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Shuu-Jiun Wang

  6. Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Shuu-Jiun Wang

  7. Department of Neurology, Taipei Veterans General Hospital, Taiwan, No. 201, Section 2, Shipai Road, Beitou 112, Taipei, Taiwan

    Shuu-Jiun Wang

Authors
  1. Chia-Lin Tsai
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  2. Guan-Yu Lin
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  3. Sheng-Kai Wu
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  4. Fu-Chi Yang
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  5. Shuu-Jiun Wang
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Correspondence to Fu-Chi Yang or Shuu-Jiun Wang.

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Chia-Lin Tsai, Guan-Yu Lin, Sheng-Kai Wu, Fu-Chi Yang, and Shuu-Jiun Wang declare no conflict of interest.

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This article is part of the Topical Collection on Chronic Daily Headache

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Tsai, CL., Lin, GY., Wu, SK. et al. Chronic Cluster Headache Update and East–West Comparisons: Focusing on Clinical Features, Pathophysiology, and Management. Curr Pain Headache Rep 24, 68 (2020). https://doi.org/10.1007/s11916-020-00902-7

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