Top health: What are the causes of cluster headache?
Dr Catherine Roos, Head of the Headache Emergency Center at Lariboisière Hospital (Paris): It is believed that the hypothalamus is strongly involved in the origin of seizures because, under medical imaging, we observe that it is activated during them, but we do not know everything. There is also a genetic component but no specific gene has yet been identified. The pain is explained by the activation of the trigeminal nerve of the face. But the name of the disease, which dates from its discovery, is incorrect. Even if there is certainly a vasodilator dimension, the disease is not of vascular origin.
Top health: What are the treatments?
Dr Roos: The first-line treatment of seizures involves injections of drugs from the triptan family. They act as serotonergic agonists on central neuronal and vascular receptors. In relay, or if one makes several attacks per day, oxygen therapy has its place. Its mode of action is not known, but it is assumed that after a short vasoconstrictor effect, vasodilatation occurs which would stimulate the neurotransmission of certain seizure inhibitors.
Top health: And what about chronic forms of the disease?
Dr Roos: Studies show that, to stop crises as long as possible, the future lies in disease-modifying treatments, such as injectable anti-CGRP antibodies, expected in France within a year. On the neurosurgical level, new neuromodulation approaches are also being developed. They target cervical stimulation and stimulation of the sphenopalatine nerve (nerve that is located behind the nasal cavities, near the brainstem).
