Triptans for acute cluster headache

Abstract

Background Cluster headache is an uncommon, but severely painful and disabling condition, with rapid onset. Validated treatment options are limited, and first-line therapy includes inhaled oxygen. Alternative therapies such as intranasal lignocaine and ergotamine are not as commonly used and are less well studied. Triptans are successfully used to treat migraine attacks and, because of this, they may also be useful for cluster headache. Objectives To determine the efficacy and tolerability of triptans for the acute treatment of cluster headaches. Search methods We searched Cochrane CENTRAL, MEDLINE and EMBASE for studies through 22 January 2010. Selection criteria Randomised, double-blind, placebo-controlled studies of triptans for acute treatment of cluster headache episodes. Data collection and analysis Two review authors independently assessed study quality and extracted data. Numbers of participants with different levels of pain relief, requiring rescue medication and experiencing adverse events and headache-associated symptoms in treatment and control groups were used to calculate relative risk and numbers needed to treat (NNT) and harm (NNH). Main results All six included studies used a single dose of triptan to treat an attack of moderate to severe pain intensity. In total 231 participants received zolmitriptan 5 mg, 223 received zolmitriptan 10 mg, 131 received sumatriptan 6 mg, 88 received sumatriptan 12 mg, and 326 received placebo. Zolmitriptan was administered either orally or intranasally, and sumatriptan either subcutaneously or intranasally. Overall, the triptans studied were better than placebo for headache relief and pain-free responses, with an NNT of 2.4 for 15 minute pain relief with subcutaneous sumatriptan 6 mg (75% with sumatriptan and 32% with placebo), and 2.8 for 30 minute pain relief with intranasal zolmitriptan 10 mg (62% with zolmitriptan and 26% with placebo). Fewer participants need rescue medication with triptan than with placebo, but more experienced adverse events. Authors’ conclusions Zolmitriptan and sumatriptan are effective in the acute treatment of cluster headaches and may provide a useful treatment option, potentially offering convenience over oxygen therapy and a better safety and tolerability profile than ergotamine. Non-oral routes of administration are likely to provide better and more rapid responses.

Serotonin and Neuropeptides in Blood From Episodic and Chronic Migraine and Cluster Headache Patients in Case‐Control and Case‐Crossover Settings: A Systematic Review and Meta‐Analysis

“…This SR‐MA also found that the 5‐HT blood levels were increased in the ictal compared with the interictal headache phase in episodic migraine 16‐18,58 . Even though triptans are used to treat acute attacks of migraine 59 and CH, 60 we did not observe a significant change of 5‐HT in whole blood during the ictal headache phase in CH, 55 a finding confirmed more recently 61…”

Evidence for efficacy of acute treatment of episodic tension-type headache: Methodological critique of randomised trials for oral treatments

“…These additional outcomes are similar to the reporting of outcomes seen in Cochrane Reviews of acute treatments for migraine [40]; cluster headache, although not in any way comparable with TTH, also uses early outcomes because these headaches usually resolve naturally in about an hour [41]. One-hour outcomes might be particularly important in studies of formulation or route of administration of drugs in which speed of onset was an issue.…”

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

“…Le zolmitriptan oral à 2,5 mg est disponible en France, a une AMM dans le traitement de la crise de migraine, mais pas dans celui de la crise d'AVF. Enfin, une récente analyse Cochrane recommande uniquement le sumatriptan SC et le zolmitriptan pernasal, ne laissant aucune place aux triptans par voie orale [71].…”