This article is more than 5 years old. Information may no longer be current.
Episodic cluster headaches treated with more acute, less preventive medications
PHILADELPHIA — Patients with episodic cluster headache are more frequently treated with acute medications than preventive treatments, suggesting that guidelines for preventive treatments may be needed, according to study results presented at the American Headache Society Annual Scientific Meeting.
“Episodic cluster headache is a debilitating, extremely painful primary headache disorder in which patients can experience multiple unilateral headache attacks per day,” J. Scott Andrews, PharmD, health economist at Eli Lilly, said during the presentation. “There are a number of treatment strategies for the management of cluster headache, including a focus on resolving attacks with acute treatments, as well as reducing the frequency of attacks within an active period with preventive treatments.”
“There’s very limited information to inform the selection of treatments, in particular for preventive treatments, or even information that describes how treatments are used in routine practice,” he continued.
Researchers used data from a cross sectional survey of physicians and their patients with cluster headache, the Adelphi 2017 Cluster Headache Diseases Specific Programme, to evaluate cluster headache treatment patterns in different regions. The survey included data from physicians and patients in Germany, the United States and the United Kingdom.
On average, patients included in the study reported 2.4 headache attacks each day.
A total of 1,102 patients with episodic migraine were included in the study, of whom 48% received acute therapy only, 38% received combined acute and preventive therapy, and 10% received only preventive treatment. Among the 375 patients from the United States, 43% received only acute treatment, 42% received both acute and preventive treatment and 12% only received preventive treatment.
In the United States, 62% of patients were prescribed sumatriptan, 19% of patients were prescribed oxygen, and 9% were prescribed zolmitriptan.
Researchers noted that oral and injection sumatriptans were used at similar levels across all countries, despite guidelines that recommend the use of fast-onset treatments such as injections and nasal sprays for episodic cluster headaches.
The majority of patients with episodic cluster headaches received no preventive treatment. When preventive treatment was attempted, the most common agent used was verapamil, which was prescribed in 29% of patients overall and in the United States.
A total of 123 of all patients, 47 from the United States, reported discontinuing preventive treatment, primarily due to lack of efficacy and tolerability issues. According to Andrews, this finding suggests that further preventive treatment options are needed.
Andrews noted that the significant number of patients who were not given preventive therapy led researchers to believe that “increased awareness, educational efforts that aim at promoting the need and benefit for preventive treatment for these patients [are] warranted, and that’s including treatment guidelines.” – by Erin Michael
Reference:
Nichols, et al. Acute and preventive treatment patterns in episodic cluster headache: Findings from the United States, United Kingdom and Germany. Presented at: American Headache Society Annual Scientific Meeting; July 11-14, 2019; Philadelphia.
Disclosures: Andrews in an employee of Eli Lilly.