EAN guidelines on the treatment of cluster headache and other trigeminalautonomic cephalalgias (TAC)

Background: Trigeminal-autonomic cephalalgias (TACs) are relatively rare, but very disabling primary headache disorders with a major impact on the patients' quality of life. Objectives: To present evidence-based recommendations for the treatment of TACs derived from a systematic review of the literature and consensus among a panel of experts. Methods: The databases PubMed (Medline), Science Citation Index, and the Cochrane Library were screened for studies on the effectiveness of interventions for cluster headache, paroxysmal hemicrania, hemicrania continua, SUNA syndrome and SUNCT syndrome. The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology and the level of evidence was established using Grading of Recommendations Assessment, Development and Evaluation (GRADE). For cluster headache recommendations were principally based on controlled trials, while recommendations for other TACs include evidence from case-studies and case-series. Recommendations: A detailed list of recommendations for the acute and preventive treatment of cluster headache are recommended. Nerve stimulation is also used but there is limited evidence for its effectiveness. There is a strong recommendation for paroxysmal hemicrania for indomethacin but otherwise only weak recommendations for the remaining TAC's. The guideline recommendations will be presented and discussed.