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.

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.

Subcutaneous Sumatriptan Induces Changes in Frequency Pattern in Cluster Headache Patients

2004 ◽  
Vol 44 (7) ◽  
pp. 713-718 ◽  
Author(s):  
Paolo Rossi ◽  
Giorgio Di Lorenzo ◽  
Rita Formisano ◽  
M. Gabriella Buzzi
Keyword(s):  
Cluster Headache ◽  
Frequency Pattern ◽  
Subcutaneous Sumatriptan ◽  
Headache Patients

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

Evaluation of guideline-adherent treatment in cluster headache

Cephalalgia ◽  
2015 ◽  
Vol 36 (8) ◽  
pp. 760-764 ◽  
Author(s):  
Victoria Lademann ◽  
Jan-Peter Jansen ◽  
Stefan Evers ◽  
Achim Frese
Keyword(s):  
Cluster Headache ◽  
Acute Treatment ◽  
Prophylactic Treatment ◽  
Treatment Guidelines ◽  
Acute Attack ◽  
Chronic Cluster Headache ◽  
European Federation ◽  
Efficacy Rate ◽  
History Of ◽  
Headache Patients

Background Several treatment guidelines exist for cluster headache. However, it is not yet known how many cluster headache patients are treated according to these guidelines. Methods We enrolled 434 cluster headache patients with confirmed diagnosis referred to two tertiary pain centers. The history of treatment was registered and analyzed according to the treatment guidelines of the European Federation of Neurological Societies. Results Regarding acute attack treatment, 62.1% of the episodic and 71.0% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was above 92% in both groups. Regarding prophylactic treatment, 31.3% of the episodic and 50.9% of the chronic cluster headache patients were treated according to the guidelines. The efficacy rate was 92.8% for episodic and 70.9% for chronic cluster headache. Conclusion The rate of guideline-adherent treatment in cluster headache is about 70% for acute treatment and about 35% for prophylactic treatment. The efficacy of this treatment is significantly higher than the efficacy of non-guideline-adherent treatment.

Interictal pain in cluster headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1531-1534 ◽  
Author(s):  
Michael J Marmura ◽  
Scott J Pello ◽  
William B Young
Keyword(s):  
Cluster Headache ◽  
Clinical Characteristics ◽  
Chart Review ◽  
Severe Disease ◽  
Disease Process ◽  
Persistent Pain ◽  
Acute Attacks ◽  
Patients Experience ◽  
Headache Patients

Introduction: Cluster headache is characterized by severe attacks of unilateral pain, but many patients experience symptoms more commonly associated with migraine such as persistent pain. Patients and methods: We evaluated cluster headache patients using a questionnaire and chart review to determine clinical characteristics. Results: Twenty-four of 50 subjects reported interictal pain outside of their acute attacks. Sixteen reported persistent pain more than half the time while in cycle. Unlike acute attacks, this pain was generally mild. Conclusions: Subjects with persistent interictal pain were more likely to have chronic cluster, allodynia, and suboptimal response to sumatriptan, suggesting that interictal pain in cluster headache may predict a more severe disease process.

Cluster Headache Course Over Ten Years in 189 Patients

Cephalalgia ◽  
1991 ◽  
Vol 11 (4) ◽  
pp. 169-174 ◽  
Author(s):  
Gian Camillo Manzoni ◽  
Giuseppe Micieli ◽  
Franco Granella ◽  
Cristina Tassorelli ◽  
Carla Zanferrari ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Disease Duration ◽  
Chronic Cluster Headache ◽  
Chronic Patients ◽  
Chronic Form ◽  
Prophylactic Drugs ◽  
Long Duration ◽  
Episodic Cluster Headache ◽  
The Moment ◽  
Headache Patients

One-hundred-and-eighty-nine cluster headache patients, referred to Parma and Pavia Headache Centres between 1976 and 1986 with a disease duration of over 10 years, were interviewed about the course of cluster headache. They were classified as episodic (n = 140) or chronic (n = 49) cluster headache patients on the basis of course during the year of onset. Episodic patients showed the following outcome: maintenance of an episodic form (primary episodic form) in 80.7% of cases, shift towards a chronic form (secondary chronic form) in 12.9% and shift towards an intermediate pattern (“combined” form) in 6.4%. In chronic patients, cluster headache was still chronic (primary chronic form) at the moment of observation in 52.4% of cases, while it turned into an episodic form (“secondary” episodic form) in 32.6% and into a “combined” form in 14.3%. Nineteen patients (10%) had had no attacks for at least three years at the moment of examination. We can conclude from our data that: cluster headache is a disease of long duration, perhaps lifelong; episodic cluster headache tends to worsen; chronic cluster headache may easily turn into a better prognostic episodic form; prophylactic drugs are unable to induce recovery. The following factors seem related to a poor outcome: a later onset, the male gender and a disease duration of over 20 years for the episodic forms.

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.

Accompanying Symptoms of Cluster Attacks: Their Relevance to the Diagnostic Criteria

Cephalalgia ◽  
1992 ◽  
Vol 12 (3) ◽  
pp. 165-168 ◽  
Author(s):  
Giuseppe Nappi ◽  
Giuseppe Micieli ◽  
Anna Cavallini ◽  
Carla Zanferrari ◽  
Giorgio Sandrini ◽  
...  
Keyword(s):  
Cluster Headache ◽  
Diagnostic Criteria ◽  
High Frequency ◽  
Nausea And Vomiting ◽  
Autonomic Symptoms ◽  
High Prevalence ◽  
Accompanying Symptoms ◽  
Central Drive

Two-hundred-and-fifty-one consecutive cluster headache (CH) patients referred to the Pavia and Parma Headache Centers were evaluated in order to verify the presence and recurrence of one or more autonomic symptoms. Data obtained show that in 2.8% of patients cluster attacks were not accompanied by localized autonomic symptoms, thus confirming the report of Ekbom. We observed a high prevalence of photophobia, nausea and vomiting. The IHS diagnostic criteria for CH may need to be modified. The high frequency of “general” autonomic symptoms seems to suggest a component of “central” drive in the physiopathology of cluster headache.

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