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

Ekbom, Karl; Monstad, Iril; Prusínski, A; Cole, JA; Pilgrim, AJ; Noronha, Drusilla

doi:10.1111/j.1600-0404.1993.tb04189.x

Cited by 166 publications

(113 citation statements)

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“…Most required that participants had previously tolerated treatment with a triptan, and/or had no contraindications, but Ekbom 1991 and Ekbom 1993 recruited only sumatriptan-naïve participants. In four studies participants self-treated their headaches at home (Bahra 2000;Cittadini 2006;Van Vliet 2003), while in the other two medication was administered by a physician or nurse in hospital (Ekbom 1991;Ekbom 1993). We included these hospital-based studies because although the intervention was not self-administered in these cases, subcutaneous sumatriptan can be, and is commonly, self-administered.…”

Section: Assessment Of Reporting Biases-no Formal Tests Were Plannedmentioning

confidence: 99%

“…Most studies evaluated headache relief and pain-free response at 30 minutes as the primary outcome measure. Two of the six studies evaluated headache relief and painfree response as the primary outcome measure at an earlier time of 15 minutes (Ekbom 1991;Ekbom 1993). One study Excluded studies-Two publications describing three trials were excluded (Goadsby 1994;Hardebo 1998).…”

Section: Assessment Of Reporting Biases-no Formal Tests Were Plannedmentioning

confidence: 99%

“…Three studies scored 5/5 (Bahra 2000;Ekbom 1991;, and three scored 4/5 (Cittadini 2006;Ekbom 1993;Van Vliet 2003). Points were lost due to failure to adequately report the method of randomisation or blinding.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Triptans for acute cluster headache

Law¹,

Derry²,

Moore³

2009

Cochrane Database of Systematic Reviews

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Section: Assessment Of Reporting Biases-no Formal Tests Were Plannedmentioning

confidence: 99%

Section: Assessment Of Reporting Biases-no Formal Tests Were Plannedmentioning

confidence: 99%

See 1 more Smart Citation

Triptans for acute cluster headache

Law¹,

Derry²,

Moore³

2009

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

“…Sumatriptan as 6mg subcutaneous injections has been shown to terminate attacks within a few minutes. [17][18][19] Sumatriptan nasal spray is also …”

Section: Triptansmentioning

confidence: 99%

Prevention and treatment of cluster headache

Cohen¹,

Goadsby²

2009

Prog Neurol Psychiatry

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CCluster headache (CH) is a stereotypical primar y headache syndrome, characterised by attacks of unilateral excruciating pain usually in the eye, periorbital region and temple, with associated cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal blockage, rhinorrhea, ptosis, and eyelid oedema. Restlessness and agitation also feature prominently. Attacks last for 15-180 minutes, and have a frequency of one every other day up to eight a day. 1 They can be triggered by alcohol, 2 usually in under an hour, in contrast to migraine for which alcohol typically takes longer to trigger an attack. CH attacks often occur with so-called clock-like regularity, and may be precipitated by sleep.CH has a prevalence of 0.1 to 0.3 per cent in the general population, 3 and affects slightly more men than women, with a male: female ratio of 2.5:1 in a recent study. 2 Episodic cluster headache (ECH) is defined as bouts of attacks lasting from seven days up to one year, with breaks of one month or more between bouts. In chronic cluster headache (CCH) attacks occur for more than one year without remission, or with remissions lasting less than one month. In CCH there are micro-periods, and seasonal variation is sometimes seen. Unaware of this, clinicians and patients may feel prophylactics have 'stopped working' although in fact the disorder has changed. Over years this can lead to a creeping upwards of medicine doses and eventual accrual of side-effects. If one is aware of the phenomenon of periodicity even in CCH, the physician can, after a period of increased dosing, revert to the previous dose, or preferably use other strategies for short-term care to avoid changing the baseline preventive dose.CH is probably the most severe pain known to humans, with female patients describing each attack as worse than childbirth. Health-related quality of life is significantly impaired in CH suf ferers. 4,5 Even though it is under-recognised and often suboptimally managed in primary care, 6,7 an early diagnosis and prompt treatment are essential to alleviate the devastating morbidity of these attacks. 8 DiagnosisThe diagnosis is usually clear on taking a thorough history. The presence of autonomic symptoms, restlessness, and the length of the attacks usually distinguishes this from migraine, although a proportion of migraine patients may exhibit cranial autonomic features, 9-11 and migraine can coexist with CH by chance. The differential diagnosis for CH includes the other trigeminal autonomic cephalalgias (TACs), which are paroxysmal hemicrania (PH) and SUNCT (shor t-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), although these dif fer from CH in that the attack lengths are shorter. 1 There is considerable overlap in attack frequency, such that typical CH patients have one to two attacks a day, typical PH patients 10 and typical SUNCT/SUNA patients 50, there is a marked skew that favours lower attack frequencies. 12 Another useful clinical pointer is the lateralisation of photo...

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“…Unlike migraine patients, patients with CH generally do not lie still during attacks and may pace with agitation and restlessness [11,12]. Acute CH medications include triptans, dihydroergotamine (DHE), inhaled oxygen, and intranasal lidocaine or capsacin [12][13][14][15]. Often CH occurs in cycles lasting weeks to months at a time with prolonged remissions.…”

Section: Cluster Headachementioning

confidence: 99%