Cluster headache treatment dilemmas: The experts respond

Loder, Elizabeth; Rizzoli, Paul; McGeeney, Brian E.; Ward, Thomas N.; Levin, Morris; Shapiro, Robert E.; Tepper, Stewart J.; Newman, Larry; Sheftell, Fred D.; Rapoport, Alan M.; Markley, Herbert G.

doi:10.1007/s11916-007-0012-z

Cited by 1 publication

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References 38 publications

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“…For example, a survey of 10 headache specialist physicians queried about SC SM administration in a hypothetical vignette of a patient with CH and with known coronary artery disease. 39 Five physicians stated they would avoid SC SM, primarily due to the contraindication. The remaining 5 physicians would provide this drug, with most justifying their decision based on CH’s harsh pain severity coupled with patients’ willingness to accept risks in order to use an effective medication, adding that they would clearly explain and document these risks.…”

Section: Sumatriptanmentioning

confidence: 99%

Cluster Headache: Opportunities for Pharmacists to Improve Care

Wenzel

Smith

Clark

2020

Journal of Pharmacy Practice

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Cluster headache (CH) is a primary headache (PH) disorder characterized by recurrent attacks of severe/extremely severe unilateral pain and associated symptoms. While less prevalent than other PHs such as migraine, CH impact is substantial given the agonizing pain, negative effect on daily productivity, impaired mental health, and increased costs. Cluster headache is not optimally treated and few clinical trials are available to model therapy, especially dosing and administration. Pharmacists are well positioned to help prescribers and CH individuals with several key opportunities. Subcutaneous sumatriptan (SC SM) lower than the FDA-approved 6 mg per attack, specifically 2 mg and 3 mg, can be considered; literature describes these doses’ benefits. Moreover, lower doses may improve patient access to this treatment-of-choice. Despite the SC SM’s FDA-approved dose limit of 12 mg per 24 hours, the maximum CH dose has not been examined; this limit merits reevaluation since literature and clinical experience illustrate treatment exceeding this limit. Oxygen therapy for CH remains unfamiliar to, and under-utilized by, clinicians and CH individuals. Pharmacists can facilitate prescribing, distribution, and administration of oxygen via education. Patient education for the various CH medication devices, including oxygen, is paramount. Narcotics remain widely prescribed for CH, without supporting evidence, but with considerable abuse and diversion risks. Pharmacists are positioned to help guard against narcotic usage and to direct care toward medications endorsed by CH guidelines. Since the optimal method to initiate and discontinue drugs which may decrease CH attacks’ remains unknown, pharmacists can educate clinicians and individuals with CH to make fully informed decisions.

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Section: Sumatriptanmentioning

confidence: 99%