Induction of cluster headache after opening of adenosine triphosphate-sensitive potassium channels: a randomized clinical trial

Haidar M Al-Khazali, Christina I Deligianni, Lanfranco Pellesi, Mohammad Al-Mahdi Al-Karagholi, Håkan Ashina, Basit Ali Chaudhry, Anja Sofie Petersen, Rigmor H Jensen, Faisal Mohammad Amin, Messoud Ashina*

*Corresponding author for this work
2 Citations (Scopus)

Abstract

Activation of adenosine triphosphate-sensitive potassium (KATP) channels has been implicated in triggering migraine attacks. However, whether the opening of these channels provoke cluster headache attacks remains undetermined. The hallmark of cluster headache is a distinct cyclical pattern of recurrent, severe headache episodes, succeeded by intervals of remission where no symptoms are present. In our study, we enrolled 41 participants: 10 with episodic cluster headaches during a bout, 15 in the attack-free remission period, and 17 diagnosed with chronic cluster headaches. Over 2 distinct experimental days, participants underwent a continuous 20-minute infusion of levcromakalim, a KATP channel opener, or a placebo (isotonic saline), followed by a 90-minute observational period. The primary outcome was comparing the incidence of cluster headache attacks within the postinfusion observation period between the levcromakalim and placebo groups. Six of 10 participants (60%) with episodic cluster headaches in bout experienced attacks after levcromakalim infusion, vs just 1 of 10 (10%) with placebo (P = 0.037). Among those in the remission phase, 1 of 15 participants (7%) reported attacks after levcromakalim, whereas none did postplacebo (P = 0.50). In addition, 5 of 17 participants (29%) with chronic cluster headache had attacks after levcromakalim, in contrast to none after placebo (P = 0.037). These findings demonstrate that KATP channel activation can induce cluster headache attacks in participants with episodic cluster headaches in bout and chronic cluster headache, but not in those in the remission period. Our results underscore the potential utility of KATP channel inhibitors as therapeutic agents for cluster headaches.

Original languageEnglish
JournalPain
Volume165
Issue number6
Pages (from-to)1289-1303
Number of pages15
ISSN0304-3959
DOIs
Publication statusPublished - 1 Jun 2024

Keywords

  • Adult
  • Cluster Headache/drug therapy
  • Cromakalim/therapeutic use
  • Double-Blind Method
  • Female
  • Humans
  • KATP Channels/metabolism
  • Male
  • Middle Aged
  • Young Adult
  • Pathophysiology
  • Trigeminal-autonomic reflex
  • Pain

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