Terapijske mogućnosti kod cluster glavobolje

master's thesis

• Title (english): Treatment options for cluster headache
• Author: Veronika Knežić
• Mentor: Lidija Bach-Rojecky (mentor)
• Committee member: Lidija Bach-Rojecky (predsjednik povjerenstva)
• Committee member: Maja Ortner Hadžiabdić (član povjerenstva)
• Committee member: Anita Somborac Bačura (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2022-11-30, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cluster glavobolja je najbolnija primarna glavobolja koja se ubraja u trigeminalne autonomne cefalgije (TAC).
Karakterizirana je snažnim jednostranim napadajima koji se javljaju u nakupinama (tzv. klasterima) između kojih su
razdoblja remisije. Napadaj boli traje 15 do 180 minuta te je praćen lakrimacijom, rinorejom i crvenilom oka. Ovisno o
trajanju remisije između napadaja, cluster glavobolja se dijeli na epizodičnu i kroničnu cluster glavobolju.
Patofiziologija cluster glavobolje je složena i još uvijek nije u potpunosti razjašnjena. Prema dosadašnjim saznanjima
u patogenezu cluster glavobolje uključeni su trigeminovaskularni sustav, autonomni sustav i hipotalamus. Također,
važnu ulogu u patogenezi imaju neuropeptidi kao što su CGRP, PACAP-38 i VIP.
Liječenje cluster glavobolje može biti usmjereno na prekidanje akutnog napadaja ili na prevenciju napadaja. Za akutno
liječenje najčešće se koriste kisik i triptani, a za profilaktičko liječenje verapamil i litij. Kortikosteroidi su se pokazali
korisnima na početku epizodične cluster glavobolje dok dugoročna prevencija ne postane učinkovita. Galkanezumab se
pokazao učinkovitim u profilaktičkom liječenju kod pacijenata s epizodičnom cluster glavoboljom. U liječenju i
prevenciji važnu ulogu imaju i neurostimulacijske tehnike kao što su neinvazivna stimulacija živca vagusa, duboka
mozgovna stimulacija, stimulacija sfenopalatinskog ganglija i invazivna stimulacija okcipitalnog živca.
Cilj akutnog liječenja cluster glavobolje je olakšati simptome i skratiti trajanje boli, dok se preventivnim liječenjem
nastoji smanjiti frekvencija napadaja, kao i njihov intenzitet. Kako bi se postigli željeni terapijski ciljevi, nužno je
pacijente s cluster glavoboljom educirati o samoj bolesti i pravilnoj primjeni lijekova. Upravo u tome važnu ulogu imaju
farmaceuti kao educirani posrednici između liječnika i pacijenata.

Abstract (english)

Cluster headache is the most painful primary headache that is included in trigeminal autonomic cephalgias (TACs). It is
characterized by strong unilateral attacks that occur in clusters between periods of remission. The pain attack lasts 15
to 180 minutes and is accompanied by lacrimation, rhinorrhea and redness of the eye. Depending on the duration of the
remission between attacks, cluster headache is divided into episodic and chronic cluster headache.
The pathophysiology of cluster headache is complicated and not yet fully understood. According to current knowledge,
the trigeminovascular system, the autonomic system and the hypothalamus are involved in the pathogenesis of cluster
headaches. Neuropeptides such as CGRP, PACAP-38 and VIP are also an important part of pathogenesis.
Treatment of cluster headache can be aimed at terminating an acute attack or at preventing it. Oxygen and triptans are
most often used for acute treatment, while verapamil and lithium are used for prophylactic treatment. Corticosteroids
were shown useful at the onset of episodic cluster headache until long-term prevention becomes effective. Galcanezumab
was shown effective in the prophylactic treatment of patients with episodic cluster headache. Neurostimulation
techniques such as non-invasive vagus nerve stimulation, deep brain stimulation, sphenopalatine ganglion stimulation
and invasive occipital nerve stimulation also play an important role in treatment and prevention.
The goal of acute treatment of cluster headache is to relieve symptoms and shorten the duration of pain, while preventive
treatment aims to reduce the frequency of attacks, as well as their intensity. To achieve the desired therapeutic goals, it
is necessary to educate patients with cluster headaches about the disease itself and the proper use of medications. This
is exactly where pharmacists play an important role as educated mediators between doctors and patients.

• Keywords: cluster glavobolja; epizodična cluster glavobolja; kronična cluster glavobolja; trigeminovaskularni sustav; hipotalamus; akutno liječenje; profilaktičko liječenje; farmakoterapija
• Keywords (english): cluster headache; episodic cluster headache; chronic cluster headache; trigeminovascular system; hypothalamus; acute treatment; preventative treatment; pharmacotherapy
• Language: croatian
• URN:NBN: urn:nbn:hr:163:745149
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-12-01 12:08:50