Anti-CGRP in Cluster Headache therapy

Background and Aim: Cluster Headache (CH) is a primary headache characterized by recurring excruciating pain and autonomic signs leading to significant suffering and derangement of patients' life. Efficacious new preventive treatments are needed. The pathophysiology of cluster headache comprises mechanisms both in the peripheral and central nervous system, involving the trigemino-para sympathetic reflex, and central modulating systems. Calcitonin gene-related peptide (CGRP) has an active role throughout these systems. It is increased during spontaneous and provoked attacks and itself can induce attacks. Recently drugs against this neuropeptide have been develop for the treatment of cluster headache. Monoclonal antibodies vs CGRP as galcanezumab and fremanezumab have been tested in cluster headache, with promising results for the episodic form. Considering the relevance of central mechanisms in CH, drugs interfering with the CGRP pathway in the central nervous system can enlarge the therapeutic armamentarium against this highly disabling condition. Conclusion: Monoclonal antibodies against CGRP have the potential to improve cluster headache. Two trials exploring anti-CGRP monoclonal antibodies efficacy for the prevention of chronic CH.  

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Stroke