Cluster headache management and beyond

The therapeutic management of cluster headache is based on a very stable triad of drugs. Acute treatment has, in subcutaneous sumatriptan, its gold standard if compared to pure oxygen or indomethacin. Preventative treatment is based on verapamil at high doses (≥ 360 mg) and is a gold standard if compared to lithium carbonate or topiramate. Transitional treatments, based on the short-term use of corticosteroids with either systemic or local administration (GON), can be useful for the suppression of most resistant cluster periods, but with a well-known carry-over phenomenon related to the length of the cluster period itself. The role of invasive or noninvasive neuromodulation approaches must still be determined on a large scale; therefore, its use is not recommended as of yet. Lifestyle changes, including alcohol avoidance during the active phase of the disease, sleep hygiene and use of vasodilation drugs, should be carefully considered and the patients should be fully informed

The therapeutic armamentarium in migraine is quite elderly.

Global Burden of Disease 2010 study considers migraine as one of the most important noncommunicable diseases in the world, classifying it third in terms of global prevalence (14.70%): it sums up the 54.19% of all the years of life lived with disabilities caused by the rest of all neurological disorders. This Editorial provides an historical excursus of old and new-entry molecules in migraine therapeutic area. Drugs for acute treatment such as triptans date back to the early 1990s with the appearance of sumatriptan and the following six triptans in the years immediately after (zolmitriptan, rizatriptan, naratriptan, eletriptan, almotriptan, frovatriptan). Prophylaxis drugs, dedicated to patients with medium/high frequency of crises, show as last entries topiramate and botulinum toxin type A. The use of this preventative group, with its intrinsic limits, is mandatory to reduce the risk of migraine chronification, a highly harmful clinical phenomenon that produces as its natural consequence the medication overuse headache. The development of new acute and preventative compounds, such as 5HT (serotonin) 1F receptor (5-HT1F) agonist lasmiditan, calcitonin gene related peptide (CGRP) peptide receptor antagonists, anti-CGRP monoclonal antibodies (LY2951742, ALD403, LBR101) and anti-CGRP-r monoclonal antibody (AMG334), is warranted and might be soon completed in order to offer new opportunities to migraine patients

Acute treatment of migraine: quo vadis?

Migraine represents the third cause of disability in the worldwide population aged under 50 years. Facing this enormous social impact, only onabotulinumtoxinA has been evaluated, on serendipity basis, as effective chronic migraine preventative treatment [1]. Pharmacological research is now moving important steps forward towards bridging the 30-year gap of new preventative class drugs for migraine, with a new molecule in its final phase of development: monoclonal antibodies for calcitonin gene-related peptide (CGRP) or its receptors (CGRPr) [2,3]. In the development pipeline of new drugs for the acute treatment, there is only one innovative compound, lasmiditan [4], while there are numerous devices and nutraceuticals in both categories [5]. This is surely not the scenario that one billion of migraine patients is hoping for from scientific research, and a new call for action is required in order to promote the study on new innovative drugs for the acute treatment of migraine. This would reduce the personal, working, and pharmaco-economic impact and the public health expenditure caused by this pathology, that could be appropriately defined as a social disease from now on

The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine

Migraine remains one of the biggest clinical case to be solved among the non-communicable diseases, second to low back pain for disability caused as reported by the Global Burden of Disease Study 2016. Despite this, its genetics roots are still unknown. Its evolution in chronic forms hits 2-4% of the population and causes a form so far defined Medication Overuse Headache (MOH), whose pathophysiological basis have not been explained by many dedicated studies. The Global Burden of Disease Study 2016 has not recognized MOH as independent entity, but as a sequela of Chronic Migraine. This concept, already reported in previous studies, has been confirmed by the efficacy of OnabotulinumtoxinA in Chronic Migraine independently from the presence of MOH. The consistency of the current definitions of both Medication Overuse Headache and Chronic Migraine itself might be re-read on the basis of new evidences

Erenumab is effective in reducing migraine frequency and improving physical functioning

no abstract availabl

Pituitary adenylate-cyclase-activating polypeptide (PACAP). another novel target for treatment of primary headaches?

No abstract availabl

P064. 12 years of Master Degree in Headache Medicine at Sapienza University of Rome

The Master in Headache Medicine has accomplished its 12th cycle of lif

Choosing the safest acute combination therapy during prophylactic treatment. pharmacokinetic and pharmacodynamic considerations

Drugs used in the treatment of migraine have been recently reported to be highly associated with the occurrence of clinically significant drug-drug interactions (DDIs)

Chronicling the June conundrum

[No abstract available

Air pollution and the novel covid-19 disease. a putative disease risk factor

Editoria