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Prophylactic Drugs

  • Andrea NegroEmail author
  • Paolo Martelletti
Chapter
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Part of the Headache book series (HEAD)

Abstract

Prophylactic treatment is the mainstay in the management for both episodic and chronic cluster headache (CH).

The primary goal of prophylactic treatment is to shorten cluster episodes and reduce the number of attacks during the bouts and maintain the patient attack-free for all the expected duration of the cluster period.

Prophylactic therapy often becomes effective quite rapidly, but unfortunately total attack suppression is not always achievable, and patients need to wait the natural ending of the bouts.

There are fundamental principles in the pharmacological prevention of CH: medications should be selected on the basis of CH course (episodic or chronic), attack frequency and duration, pain intensity, contraindications, and patients comorbidities; prophylaxis should begin at the first signals of the start of a new cluster bout, maintained during the cluster period and then discontinued by slowly tapering the doses after full remission; treatments for chronic CH may need to be continued for very long periods. Combinations of prophylactic medications are often required, particularly for chronic CH patients.

Only few randomized clinical trials have evaluated preventive drugs in CH; hence decisions on treatments often rely on insufficient body of evidence.

In 2006 a Task Force of the European Federation of Neurological Societies (EFNS) published comprehensive guidelines on the treatment of cluster headache.

Keywords

Cluster headache Cluster headache prophylaxis Prophylactic drugs Prophylactic treatments 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sant’Andrea HospitalSapienza University of RomeRomeItaly

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