Subcutaneous sumatriptan in the acute treatment of cluster headache: a dose comparison study

2009 ◽  
Vol 88 (1) ◽  
pp. 63-69 ◽  
Author(s):  
K. Ekbom ◽  
I. Monstad ◽  
A. Prusinski ◽  
J. A. Cole ◽  
A. J. Pilgrim ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Acute Treatment ◽  
Comparison Study ◽  
Dose Comparison ◽  
Subcutaneous Sumatriptan

Advances in Medical Management of Cluster Headache

2009 ◽  
Vol 4 (2) ◽  
pp. 95
Author(s):  
Stefan Evers ◽  
Keyword(s):  
Cluster Headache ◽  
Surgical Procedures ◽  
Acute Treatment ◽  
Maximum Dose ◽  
Controlled Trials ◽  
Scientific Evaluation ◽  
First Choice ◽  
Daily Dose ◽  
Subcutaneous Sumatriptan ◽  
Zolmitriptan Nasal Spray

Cluster headache is a rare but extremely disabling condition. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 7l/minute, 6mg subcutaneous sumatriptan and 5mg zolmitriptan nasal spray are the drugs of first choice. Prophylaxis of cluster headache should be performed with verapamil in a daily dose of at least 240mg (maximum dose depends on efficacy and tolerability). Although no placebo-controlled trials are available, steroids are clearly effective in cluster headache. Methylprednisone (or equivalent corticosteroid) at least 100mg orally or up to 500mg intravenously per day over five days (then tapering down) is recommended. Methysergide, lithium and topiramate are recommended as drugs of second choice. Although in part promising, surgical procedures require further scientific evaluation before they can be recommended.

Cluster headache not responsive to sumatriptan: A retrospective study

Cephalalgia ◽  
2020 ◽  
pp. 033310242095670
Author(s):  
Luca Giani ◽  
Alberto Proietti Cecchini ◽  
Alberto Astengo ◽  
Giuseppe Lauria ◽  
Massimo Leone
Keyword(s):  
Cluster Headache ◽  
High Frequency ◽  
Acute Treatment ◽  
Clinical Characteristics ◽  
Pain Mechanisms ◽  
Long Duration ◽  
Subcutaneous Sumatriptan ◽  
Relevant Role ◽  
Clinical Records ◽  
Headache Patients

Introduction Subcutaneous sumatriptan, a 5HT1B/1D agonist, is the most effective drug in cluster headache acute treatment. About 25% of the patients do not respond to subcutaneous sumatriptan; the reasons for this are unknown. In this study, we compare clinical characteristics of cluster headache patients responding and non-responding to subcutaneous sumatriptan. Methods We retrospectively investigated the clinical records of 277 cluster headache patients. Patients reporting repeated satisfactory response to subcutaneous sumatriptan within 15 minutes were considered responders. Results Of 206 cluster headache patients who had used subcutaneous sumatriptan (mean age 45.6, 16% females, 48% chronic), 91% were responders, and 9% non-responders. Compared to responders, non-responders had longer and more frequent attacks: 60 (median; IQR 38–90) vs. 100 (60–120) minutes ( p = 0.028), 4 (2.5–5) vs. 3 (2–4) attacks/day ( p = 0.024). No other difference was found. Conclusions In cluster headache attacks with long duration and high frequency, pain mechanisms not involving 5HT1B/1D receptors may play a more relevant role.

Cluster Headache Attacks Treated for Up Three Months with Subcutaneous Sumatriptan (6 mg)

Cephalalgia ◽  
1995 ◽  
Vol 15 (3) ◽  
pp. 230-236 ◽  
Author(s):  
K Ekbom ◽  
A Krabbe ◽  
G Micelli ◽  
A Prusinski ◽  
JA Cole ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Acute Treatment ◽  
Vital Signs ◽  
Term Treatment ◽  
Significant Treatment ◽  
Frequent Use ◽  
Long Term Treatment ◽  
Subcutaneous Sumatriptan ◽  
Clinically Significant

In the first three months of a 24–month open study to assess the safety and efficacy of subcutaneous sumatriptan 6 mg in the long-term acute treatment of cluster headache, 138 patients treated a maximum of two attacks daily each with a single 6 mg injection. A total of 6353 attacks were treated. Adverse events, reported in 28% of sumatriptan-treated attacks, were qualitatively similar to those seen in migraine long-term trials. Their incidence did not increase with frequent use of sumatriptan. There were no clinically significant treatment effects on vital signs, ECG recordings or laboratory parameters. Headache relief (a reduction from very severe, severe or moderate pain to mild or no pain) at 15 min was obtained for a median of 96% of attacks treated. There was no indication of tachyphylaxis, decrease in the speed of response, or increased frequency of attacks with long-term treatment. This study demonstrated that, in long-term use, subcutaneous sumatriptan 6 mg is a well-tolerated and effective acute treatment for cluster headache.

scholarly journals Advances in Medical Management of Cluster Headache

US Neurology ◽  
2009 ◽  
Vol 05 (01) ◽  
pp. 75
Author(s):  
Stefan Evers ◽  
Keyword(s):  
Cluster Headache ◽  
Surgical Procedures ◽  
Acute Treatment ◽  
Maximum Dose ◽  
Controlled Trials ◽  
Scientific Evaluation ◽  
First Choice ◽  
Daily Dose ◽  
Subcutaneous Sumatriptan ◽  
Zolmitriptan Nasal Spray

Cluster headache is a rare but extremely disabling condition. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 7l/minute, 6mg subcutaneous sumatriptan, and 5mg zolmitriptan nasal spray are the drugs of first choice. Prophylaxis of cluster headache should be performed with verapamil in a daily dose of at least 240mg (maximum dose depends on efficacy and tolerability). Although no placebo-controlled trials are available, steroids are clearly effective in cluster headache. Methylprednisone (or equivalent corticosteroid) at least 100mg orally or up to 500mg intravenously per day over five days (then tapering down) is recommended. Methysergide, lithium, and topiramate are recommended as drugs of second choice. Although in part promising, surgical procedures require further scientific evaluation before they can be recommended.

Chronic intrahippocampal administration of streptozotocin targeting insulin receptors induced memory loss in rats: A dose comparison study

2018 ◽  
Vol 22 (1) ◽  
pp. 13-29
Author(s):  
Mazzura Wan Chik ◽  
◽  
Nurul Aqmar Mohamad Nor Hazalin ◽  
Gurmeet Kaur Surindar Singh ◽  
◽  
...  
Keyword(s):  
Memory Loss ◽  
Insulin Receptors ◽  
Comparison Study ◽  
Dose Comparison

Early Aneurysm Surgery and Preventive Therapy with Intravenously Administered Nimodipine: A Multicenter, Double-Blind, Dose-Comparison Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Joachim M. Gilsbach ◽  
Hans J. Reulen ◽  
Bengt Ljunggren ◽  
Lennart Brandt ◽  
Hans v. Holst ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Neurological Dysfunction ◽  
Comparison Study ◽  
Double Blind ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dose Comparison ◽  
Significant Difference ◽  
Low Incidence

Abstract A European, multicenter. prospective, randomized. double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study; surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon: patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V. the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.

A Pilot Double-Blind, Dose-Comparison Study of Risperidone in Drug-Naive, First-Episode Schizophrenia

2001 ◽  
Vol 62 (12) ◽  
pp. 994-995 ◽  
Author(s):  
Hsien-Yuan Lane ◽  
Wen-Ho Chang ◽  
Chih-Chiang Chiu ◽  
Ming-Chyi Huang ◽  
Sue-Hong Lee ◽  
...  
Keyword(s):  
First Episode ◽  
Comparison Study ◽  
Double Blind ◽  
Dose Comparison ◽  
Drug Naïve ◽  
First Episode Schizophrenia

Pharmacotherapy Options for the Management of Cluster Headache

2013 ◽  
Vol 5 ◽  
pp. CMT.S10251 ◽  
Author(s):  
Jared L. Pomeroy ◽  
Michael J. Marmura
Keyword(s):  
Adverse Events ◽  
Cluster Headache ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Good Evidence ◽  
Unilateral Headache ◽  
Acute Medication ◽  
Subcutaneous Sumatriptan ◽  
Zolmitriptan Nasal Spray ◽  
Effective Medication

Cluster headache is a primary headache syndrome characterized by attacks of severe unilateral headache typically lasting 30 to 180 minutes without treatment and prominent autonomic symptoms on the affected side. Often attacks occur in cycles lasting weeks to months with up to 8 attacks per day, and a minority of individuals continue to experience attacks throughout the year. Persons with cluster headache usually require both acute medication for attacks and preventive treatment to keep the headaches from occurring. Subcutaneous sumatriptan is the most effective medication for acute cluster attacks, but other triptans such as zolmitriptan nasal spray are also effective. inhaling 100% oxygen is also effective and is a useful treatment for those with frequent attacks or contraindications to triptans. Corticosteroids are among the most effective transitional treatments, typically used at the start of a cycle. Dihydroergotamine is an effective treatment for refractory or severe cluster headache with multiple attacks requiring large triptan doses. Verapamil and lithium are among the most effective preventive medications with good evidence of effectiveness, but other studies support the use of gabapentin, topiramate, diavalproex sodium, and methysergide, to name a few. Each of these medications requires monitoring for adverse events and can be discontinued within a few weeks of a cluster headache cycle.

Sign in / Sign up

Export Citation Format

Share Document