ماذا تفعل عندما لم يحقق فيراباميل تخفيضاً كافياً في تكرار النوبات في الصداع العنقودي النوبي

References

DOI: 10.1111/ene.15956

• the majority of patients experience an episodic pattern (80%, ICHD-3 3.1.1), with symptomatic periods (7 days to several months, most commonly 4-12 weeks) and symptom-free periods of variable duration (minimum of 3 months).
• Lithium is a drug of second choice if verapamil is inefficacious or contraindicated.
• Galcanezumab 300 mg sc every month is recommended in otherwise intractable patients based on one RCT despite missing labeling by the European authorities.
• In a randomized placebo-controlled double-blind trial in episodic cluster headache, galcanezumab 300 mg sc was more efficacious than placebo in reducing weekly attack frequency at the primary endpoint of 3 weeks.
• Clinical efficacy is reached within 1 week.