Triptans for acute cluster headache

Law, Simon; Derry, Sheena; Moore, R Andrew

doi:10.1002/14651858.cd008042.pub3

Cited by 47 publications

(24 citation statements)

References 45 publications

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“…CH patients may experience symptoms typically associated with migraine, but migraine patients may also readily experience cranial autonomic symptoms [30]. In fact, there are multiple shared clinical characteristics between CH and migraine: mutual triggers [31,32], response to abortive treatments like triptans [33,34] and the potential preventive effect of the emerging anti-caltonin gene-related peptide antibodies [35,36]. These observations indicate that the mutual clinical characteristics may be epiphenomena to some shared pathophysiological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

More precise phenotyping of cluster headache using prospective attack reports

Snoer

Lund

Jensen

et al. 2019

Euro J of Neurology

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Background and purpose The clinical characteristics of cluster headache (CH) are based mainly on retrospective attack descriptions of ‘usual’ attacks, but whether these reports are reliable is uncertain. The aim was to compare retrospective and prospective attack descriptions and describe the within‐ and between‐patient variability of attacks. Method Fifty‐seven CH patients underwent a semi‐structured interview obtaining a retrospective account of usual CH attacks. Patients thereafter prospectively recorded the clinical characteristics of up to 10 attacks per patient in a headache diary. Four different attack characteristics were investigated: (i) severity, (ii) duration, (iii) number of autonomic symptoms and (iv) number of migrainous symptoms. Retrospective and prospective data were compared. Within‐ and between‐patient variability of attacks was assessed. Results Retrospective attack descriptions (n = 57) were significantly longer (P = 0.046) and more severe (P < 0.0001) for untreated attacks compared with prospective reports (n = 500). The number of autonomic symptoms was significantly higher in the retrospective reports compared to the prospective reports (P < 0.0001). Within‐patient variability for attack duration, pain severity and number of autonomic and migrainous symptoms was low. Compared to men, more women reported longer (P = 0.026) and more severe (P = 0.028) attacks with more migrainous symptoms (P = 0.033). Conclusions Important differences were found between prospectively and retrospectively reported attacks with duration and severity of untreated attacks overestimated in retrospective attack descriptions. CH attacks display low within‐patient variability, but the presentation of CH attacks varies between patients. The high prevalence of symptoms typically associated with migraine should raise more diagnostic awareness for CH, especially in women who are more often misdiagnosed as having migraine.

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Section: Discussionmentioning

confidence: 99%

More precise phenotyping of cluster headache using prospective attack reports

Snoer

Lund

Jensen

et al. 2019

Euro J of Neurology

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“…In summary, subcutaneous sumatriptan is effective in the acute treatment of CH giving either partial relief of pain or complete headache remission within 15 minutes of injection. The most common adverse events, mild to moderate in 90% of cases [ 113 ], are local reactions at the injection site, dizziness, paraesthesia, cold or warm sensations and irritation of the nostril in the case of the intranasal formulation [ 113 ]. Sumatriptan is contraindicated in patients with coronary artery disease or cerebrovascular disease, thus a clinical evaluation of the risk of vascular diseases is mandatory in all patients before prescribing the drug.…”

Section: The Management Of Cluster Headachementioning

confidence: 99%

The Neuropharmacology of Cluster Headache and other Trigeminal Autonomic Cephalalgias

Costa

Antonaci

Ramusino

et al. 2015

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Abstract:Trigeminal autonomic cephalalgias (TACs) are a group of primary headaches including cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Another form, hemicrania continua (HC), is also included this group due to its clinical and pathophysiological similarities. CH is the most common of these syndromes, the others being infrequent in the general population. The pathophysiology of the TACs has been partly elucidated by a number of recent neuroimaging studies, which implicate brain regions associated with nociception (pain matrix). In addition, the hypothalamic activation observed in the course of TAC attacks and the observed efficacy of hypothalamic neurostimulation in CH patients suggest that the hypothalamus is another key structure. Hypothalamic activation may indeed be involved in attack initiation, but it may also lead to a condition of central facilitation underlying the recurrence of pain episodes. The TACs share many pathophysiological features, but are characterised by differences in attack duration and frequency, and to some extent treatment response. Although alternative strategies for the TACs, especially CH, are now emerging (such as neurostimulation techniques), this review focuses on the available pharmacological treatments complying with the most recent guidelines. We discuss the clinical efficacy and tolerability of the currently used drugs. Due to the low frequency of most TACs, few randomised controlled trials have been conducted. The therapies of choice in CH continue to be the triptans and oxygen for acute treatment, and verapamil and lithium for prevention, but promising results have recently been obtained with novel modes of administration of the triptans and other agents, and several other treatments are currently under study. Indomethacin is extremely effective in PH and HC, while antiepileptic drugs (especially lamotrigine) appear to be increasingly useful in SUNCT. We highlight the need for appropriate studies investigating treatments for these rare, but lifelong and disabling conditions.

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“…Subcutaneous sumatriptan 6 mg has been shown to render 48% of patients pain free at 15 minutes versus 17% placebo (NNT 3.3), whereas intranasal zolmitriptan 10 mg only rendered 12% pain free versus 3% placebo (NNT 11). 52 Intranasal sumatriptan 20 mg was shown in one trial to render 57% patients pain free at 30 minutes versus 26% placebo. 53 High-fl ow 100% oxygen (12 l/min delivered by face mask) has been shown to render 78% pain free at 15 minutes versus 20% placebo.…”

Section: Acute and Transitional Treatments For Cluster Headachementioning

confidence: 99%

Drug therapy in headache

Weatherall

2015

Clinical Medicine

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All physicians will encounter patients with headaches. Primary headache disorders are common, and often disabling. This paper reviews the principles of drug therapy in headache in adults, focusing on the three commonest disorders presenting in both primary and secondary care: tension-type headache, migraine and cluster headache. The clinical evidence on the basis of which choices can be made between the currently available drug therapies for acute and preventive treatment of these disorders is presented, and information given on the options available for the emergency parenteral treatment of refractory migraine attacks and cluster headache.

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Triptans for acute cluster headache

Cited by 47 publications

References 45 publications

More precise phenotyping of cluster headache using prospective attack reports

More precise phenotyping of cluster headache using prospective attack reports

The Neuropharmacology of Cluster Headache and other Trigeminal Autonomic Cephalalgias

Drug therapy in headache

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