Headache society releases ‘cluster headache guidelines’ that are rare worldwide

The Korean Headache Society unveiled its cluster headache guidelines and major business plans for 2025 at an online press conference last week.

“We started developing the guidelines in March 2022 to help treat patients with cluster headaches as there is a lack of guidelines worldwide,” said Professor Kim Byung-su of the Department of Neurology at Ewha Womans University Mokdong Hospital, who serves as an academic board member of the Korean Headache Society.

Sixteen experts participated in developing the guidelines, and Dr. Choi Mi-young of the National Evidence-based Healthcare Collaborating Agency joined them as a methodology expert to strengthen the scientific evidence.

The newly released guideline for cluster headache includes recommendations for acute and preventive treatments. “Most of them were strongly recommended and recommended for active use in clinical practice,” Professor Kim said

The guidelines recommended triptans (sumatriptan subcutaneous injection, zolmitriptan nasal spray, sumatriptan nasal spray, and oral zolmitriptan) and oxygen therapy to ease acute cases. Five treatments—sublingual steroids, systemic steroids, lithium, verapamil, and calcitonin gene-related peptide antibodies—were presented for prevention.

The headache society will release highlights of the cluster headache guideline at a mini-symposium on Feb. 8, followed by a final release in March.

Besides, the society published its 2021 migraine preventive care guideline in an international journal earlier this year.

“The guidelines cover both conventional preventive treatments and CGRP (calcitonin gene-related peptide) antibody therapies, and although they are a bit dated, they are still valid,” Professor Kim said. “We plan to continue researching the harmonized use of new and existing therapies, including oral CGRP antagonists.”

In addition to the guidelines, the society also shared the insurance coverage status for new drugs.

“The U.S. and European guidelines, which are the most referenced in the world, have recently recommended that CGRP-targeted therapies be considered as first-line treatments for migraine,” said Dr. Chu Min-kyung, president of the Korean Headache Society and professor of neurology at Severance Hospital.

Regarding the reimbursement of the oral CGRP-targeting drug Aquiquita (atozepant), which was launched in Korea last year, Chu said, “Spain reimbursed it in October 2024, but other European countries, including the United Kingdom, have not yet reimbursed it. If reimbursement proceeds in Europe and Australia, new drugs are launched, and drug price competition occurs, the domestic situation may change.”

Concerning the insurance coverage standards for CGRP targeted therapies, Chu said, “Currently, it is required to be administered for one year with a six-month discontinuation period, but many countries are operating at three months, so we aim to shorten it as an interim goal in Korea.”

“In the field of migraine, discoveries have been ongoing for the past 10 to 20 years,” Professor Kim said. “CGRP-targeted therapies have only been introduced about 10 years ago, so actual clinical data is still accumulating, and new indications such as dizziness are expanding.”

“Previously, medication overuse was thought to be the main cause of headache exacerbation, but recently, a new perspective has emerged that insufficient use of acute treatment may also be a contributing factor,” he added.

Chairwoman Chu said, “Currently, the diagnosis rate of migraine in Korea is 30 percent, and the use of triptans is 10 percent. New drugs, including Rimegepant, will soon be launched in Korea, and CGRP monoclonal antibodies for pediatric patients are expected to be approved this year or next. This will further improve the treatment environment.”

The headache society also strengths its educational and research activities this year.

It will hold its spring meeting on June 22, its fall meeting on Nov. 16, and four training lectures on “New Strategies for Migraine Treatment” nationwide. The first lecture was held at Chungnam National University Hospital in mid-January and will be held at Asan Medical Center in Gangneung on April 12. In the second half of the year, lectures will be held in Busan and Gwangju.

The society will also hold a “Headache School” on Sept. 21 to train experts and a mini-symposium on Feb. 8 to share the activities of the editorial board of the international journal Head Pain Research (HPR) and present guidelines. The society is also planning to apply to participate in the 2025 International Headache Congress in Brazil.