Diagnosis and treatment of cluster headache: a differentiated clinical and genetic approach

The role of algogenic peptides — pituitary adenylate cyclase activating polypeptide (PACAP) and calcitonin gene-related peptide (CGRP) — is actively studied in cluster headache (CH). The aim of the study was to investigate genetic biomarkers of CH within the CGRP system, as well as clinical and genetic characteristics of patients sensitive and insensitive to verapamil therapy. The retrospective clinical analysis included 61 patients (48 men and 13 women) with CH, the average age was 39.3±12.2 (19—71) years. Episodic CH was suffered by 46 (75.4%) patients, chronic CH — by 15 (24.6%) patients. The genetic study included 23 patients of the main group. Patients with CH are characterized by the GG variant of RAMP1 rs7590387, as well as GT or TT variants of CSE rs1021737, CT variant of CGRP rs155209, AA variant of CSE rs482843. The RAMP1 rs7590387 CC genotype was noted in 12.5±3.4% of patients with migraine symptoms during an attack of CH, and in 57.1±5.3% of patients without migraine symptoms (p=0.004). In patients with sensitivity to verapamil, CH had an episodic form, the clinical picture was characterized by a pulsating nature of pain, with attacks occurring only at night, RAMP1 rs7590387 GC polymorphism was not detected.