Cluster Headaches

A therapeutic challenge for patients and doctors

Cluster headaches are intensely painful headaches affecting one side of the head with the pain often felt around the eye. Attacks of episodic cluster headaches occur daily over a period of weeks or months, suddenly stop and then start again after some time. Chronic cluster headaches occur regularly with symptom-free periods lasting only for a few weeks.

Cluster headache pain is described by female sufferers as being worse than the pain of childbirth and is recognized by the World Health Organisation as being amongst the worst pain known to mankind. Because of the severe impact that cluster headache has on many patients, it is often referred to as “suicide headache”.

However, despite the severity of symptom cluster headaches still remain sub-optimally treated.

Case Study

Patient’s background

Patient X was referred by his GP to a Neurologist, who confirmed a diagnosis of severe cluster headache with up to 7 attacks each day when symptoms are not controlled.

The patient has been experiencing severe cluster headache for 2 years, experiencing up to 8 attacks each day. Prior appropriate treatment, the patient suffered an average of 3 attacks per day, each approximately lasting for 50 minutes and he was unable to work for an average of 1.5 days each week. Pain intensity varied from mild to severe, with the majority deemed as moderate and in 60% of the cases, it warranted him needing to use oral sumatriptan treatment and inhaled oxygen which do not provide complete pain relief.

Therapeutic intervention provided

gammaCore – a non-invasive vagal nerve stimulation device which is FDA-approved as a prescription-only medical device (GammaCore is a prescription-only medical device, only in the US) and has a CE marking for the use in treatment of primary headaches, including cluster headaches (outside the US, including the European Union, GammaCore does not require a prescription, just authorisation), has been recommended to Patient X.

Outcome from using gammaCore

After two weeks of acute use of gammaCore the average number of cluster headaches have reduced to only 1 per day lasting about 23 minutes. Pain intensity has reduced dramatically, with most attached been deemed as mild and none as severe, meaning that no acute treatment was needed. Within the whole two weeks of using the gammaCore device no days of work were lost.

Previously failed treatments

In the past, the patient has tried several treatment options including NSAIDs, Triptans, Paracetamol, Ergot derivatives, Verapamil and centrally-acting analgesics in addition to oxygen which was always used, all providing limited relief.

Verapamil has also been trialed as prophylactic therapy, at the maximum dose of 320mg three times a day but after a year this was gradually withdrawn due to lack of response.

gammaCore place is clinically exceptional

gammaCore is the only treatment that provided the patient with cluster headache relief.

The risk of gammaCore representing an additional failed treatment option is low given that the patient has already demonstrated a positive response to treatment during the initial period of using gammaCore. Ongoing response to treatment should be closely monitored.

Local provider

The gammaCore device is manufactured and supplied by electroCore Inc. and distributed in Cyprus by Melidonia Health.

Melidonia Health

Yiannos Kranidiotis Avenue

179, Latsia 2235 Nicosia Cyprus

Tel 22741741, Email: info@melidonia.com.cy

Additional Resources

[1] M Fishera, et al. “The incidence and prevalence of cluster headache: a meta-analysis of population-based studies”. Cephalalgia June 2008

http://www.ncbi.nlm.nih.gov/pubmed/18422717

[2] LA Wilbrink, et al.  “Occipital nerve stimulation in medically intractable, chronic cluster headache.  The ICON study: rationale and protocol of a randomised trial.”  Cephalalgia 2013

http://www.ncbi.nlm.nih.gov/pubmed/23720502