Cluster headache not responsive to sumatriptan: A retrospective study

Abstract

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.

The impact of the disease burden on the quality of life of cluster headache patients

“…Hence, though there is no interictal burden without an ictal burden, focusing solely on the latter implies missing an opportunity to relieve distress because drugs cannot prevent or abort all attacks. 8,9 Based on these findings, we advocate broadening the therapeutic goals and attempting to maximise the QoL. This approach embraces the idea of patient-centred care, which holds that considering patients' families in the personalised care plan may facilitate meeting the objective of emotional-not just physical-well-being.…”

“…Hence, though there is no interictal burden without an ictal burden, focusing solely on the latter implies missing an opportunity to relieve distress because drugs cannot prevent or abort all attacks. 8,9…”

“…However, acute medication does not abort, and prophylaxis does not prevent every attack-CH can be managed but not cured. 8,9 So, it would be reasonable to endorse further therapeutic goals, to prioritise lightening its impact on life. For instance, we might ask how we can help patients thrive and obtain a desirable life position despite the disorder.…”

Management of cluster headache: Treatments and their mechanisms

“…Other real-world studies have noted that patients can obtain relief from less than 6 mg (15) and there appears to be no tachyphylaxis (14,16,17). Studies of predictors for triptan response have shown that patients with eCH (as opposed to cCH), younger patients, and patients with shorter and less frequent attacks may be more responsive to triptans (18–20). One genetic study identified a common GNB3 variant as a predictor of triptan response in CH (21), though testing for GNB3 is not commonplace in clinical practice.…”