Efficacy and safety of oral zolmitriptan in the preictal phase of episodic cluster headache
Abstract BackgroundRecent studies on cluster headache suggested that headache includes three phases.Oral zolmitriptan is effective in the treatment of acute headache attack.We aim to describe the clinical characteristics of different phases of episodic cluster headache(eCH) and observe the efficacy and safety of oral zolmitriptan in preictal phase of eCH attacks.MethodsForty-eight patients with eCH were enrolled in this study. We divided the CH attack into three phases: preictal, ictal and postictal phase and analyzed the clinical features of each phase. We collected the data of twenty-three patients who took zolmitriptan in the preictal phase of three consecutive CH attacks. The Visual Analogue Scale (VAS) score and duration of headache after three consecutive treatments were compared with the baseline respectively. Chi square test, t test, Mann Whitney U test, Pearson linear correlation analysis, paired t-test and paired non-parametric rank-sum test were used for statistical analysis.ResultsForty-five patients (93.8%) reported the presence of preictal symptoms. The most frequent preictal symptom was mild to moderate head discomfort in the area of the subsequent serious headache, accounting for 87.5%. The duration of preictal period was positively correlated with the duration of headache. The Pearson correlation coefficient was 0.313 (P=0.018). Among the twenty-three patients taking oral zolmitriptan in the preictal phase, the VAS max score was significantly lower than that of baseline headache (P<0.01). The duration of headache after three preictal administration was significantly shorter than that of baseline headache (P<0.01). The incidence of adverse reactions after taking zolmitriptan was 10.1%, including head drowsiness, neck stiffness and mild chest tightness.Conclusions Preictal symptoms were common in CH. Mild to moderate discomfort in the subsequent serious headache was the most common symptom in the preictal phase. Oral administration of zolmitriptan in the preictal period could reduce the severity of headache and shorten the duration of headache in a cluster period without serious adverse reactions.