Cluster Headache Attacks Treated for Up Three Months with Subcutaneous Sumatriptan (6 mg)

Ekbom, Karl; Krabbe, Annette; Micelli, G.; Prusínski, A; Cole, JA; Pilgrim, AJ; Noronha, Drusilla

doi:10.1046/j.1468-2982.1995.015003230.x

Cited by 104 publications

(62 citation statements)

References 8 publications

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“…However, because 5-HT 1D receptors are present on nociceptors throughout the body, it is surprising that triptans are reportedly effective treatments for only migraine and cluster headache (Ekbom et al, 1995). They are apparently not useful for other primary headache disorders (Antonaci et al, 1998), or other painful disorders of the head (Dao et al, 1995;Harrison et al, 1997), and are not used in the treatment of somatic pain conditions.…”

Section: Are Triptans General Analgesics?mentioning

confidence: 99%

Tissue Injury Regulates Serotonin 1D Receptor Expression: Implications for the Control of Migraine and Inflammatory Pain

Ahn

Basbaum²

2006

J. Neurosci.

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The anti-migraine action of "triptan" drugs involves the activation of serotonin subtype 1D (5-HT 1D ) receptors expressed on "painresponsive" trigeminal primary afferents. In the central terminals of these nociceptors, the receptor is concentrated on peptidergic dense core vesicles (DCVs) and is notably absent from the plasma membrane. Based on this arrangement, we hypothesized that in the resting state the receptor is not available for binding by a triptan, but that noxious stimulation of these afferents could trigger vesicular release of DCVs, thus externalizing the receptor. Here we report that within 5 min of an acute mechanical stimulus to the hindpaw of the rat, there is a significant increase of 5-HT 1D -immunoreactivity (IR) in the ipsilateral dorsal horn of the spinal cord. We suggest that these rapid immunohistochemical changes reflect redistribution of sequestered receptor to the plasma membrane, where it is more readily detected. We also observed divergent changes in 5-HT 1D -IR in inflammatory and nerve-injury models of persistent pain, occurring at least in part through the regulation of 5-HT 1D -receptor gene expression. Finally, we found that 5-HT 1D -IR is unchanged in the spinal cord dorsal horn of mice with a deletion of the gene encoding the neuropeptide substance P. This result differs from that reported for the Ѩ-opioid receptor, which is also sorted to DCVs, but is greatly reduced in preprotachykinin mutant mice. We suggest that a "pain"-triggered regulation of 5-HT 1D -receptor expression underlies the effectiveness of triptans for the treatment of migraine. Moreover, the widespread expression of 5-HT 1D receptor in somatic nociceptive afferents suggests that triptans could, in certain circumstances, treat pain in nontrigeminal regions of the body.

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Section: Are Triptans General Analgesics?mentioning

confidence: 99%

Tissue Injury Regulates Serotonin 1D Receptor Expression: Implications for the Control of Migraine and Inflammatory Pain

Ahn

Basbaum²

2006

J. Neurosci.

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“…The Sumatriptan Cluster Headache Study Group showed in 1991 [4] that the drug was efficient in 74% of the attacks during the first 15 minutes. Ekbom and colleagues confirmed the same thesis in 1992 [9] and 1993 [10] during, respectively, 480 attacks in one patient and 6353 attacks in 138 patients. In 2000, Centonze et al [11] noticed there were no cases of tachyphylaxis.…”

Section: Discussionmentioning

confidence: 57%

Does repeated subcutaneous administration of sumatriptan produce an unfavorable evolution in cluster headache?

et al. 2004

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Cluster headache (CH) is one of the most painful primitive headaches that exists. Since 1991, the subcutaneous administration of sumatriptan (SCS) in the treatment of acute attacks has proved to be rapid and effective. Moreover, SCS has an excellent safety-efficacy ratio. To date, there is no information on the modalities of SCS use by CH patients, and on its possible overuse. In fact, some patients have noticed that the use of this drug on a regular basis modifies the evolution of attacks. We retrospectively studied, in 67 patients admitted for CH, the modalities of self-administering SCS the subjective feeling of medication overuse and its repercussions on attacks. A total of 47 patients used exclusively SCS as an acute treatment, 30 of whom had used more than two injections daily. Four patients whose use of SCS was the highest had also been drug addicts. Twenty-two patients using exclusively SCS thought that sumatriptan could have modified the evolution of attacks: 20 patients thought that the attacks occurred more frequently; 11 commented that the attacks became more intense, and the remaining 11 patients stated that sumatriptan had become less efficient. In CH, overuse of sumatriptan could aggravate the evolution of attacks. Further research is needed to corroborate this argument.

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“…11 In CH, unlike in migraine, subcutaneous sumatriptan can be prescribed at a frequency of twice daily, on a long term basis if necessary without risk of tachyphylaxis or rebound. [12][13][14] However, in this era of a cost conscious National Health Service (NHS) some practitioners are reluctant to prescribe this relatively expensive drug. We feel, given the devastating morbidity associated with this excruciating pain syndrome, that it is unethical to withhold treatment for cost reasons.…”

Section: Neurology In Practice Triptansmentioning

confidence: 99%

Trigeminal-Autonomic Cephalgias

2002

An Atlas of Headache

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T he trigeminal autonomic cephalgias (TACs) are a group of primary headache disorders characterised by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features.1 The group comprises cluster headache, paroxysmal hemicrania, hemicrania continua, and short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome). Firstly, they must be differentiated from secondary TACs, and other short lasting primary headaches (table 1), and then from each other. The concept of a short lasting headache is naturally somewhat artificial in terms of defining "short"-that said, a typical attack time is less than four hours, in contrast with the major differential diagnosis of migraine in which attacks are usually longer.2 The differentiation between TACs is essential since the treatments are very different. Hemicrania continua is a continuous headache and should be considered in the differential diagnosis of relatively long lasting chronic daily headache (see page ii2). 3The TACs are relatively rare, which is likely to be why they are poorly recognised in primary care. TACs will thus be referred to neurologists eventually, offering an excellent opportunity to diagnose and treat these patients. It is noteworthy that each of the TACs has been seen in paediatric practice. The importance of recognising these syndromes is underscored by their excellent but highly selective response to treatment. c CLUSTER HEADACHECluster headache (CH) is a strictly unilateral headache that occurs in association with cranial autonomic features and, in most patients, has a striking circannual and circadian periodicity. It is an excruciating syndrome and is probably one of the most painful conditions known to humans. Female patients describe each attack as being worse than childbirth. EpidemiologyThe prevalence of CH is estimated to be 0.1%, 4 approximately the same as that of multiple sclerosis in the UK. The male:female ratio is 3.5-7:1. 5 6 It can begin at any age though the most common age of onset is the third or fourth decade of life. Clinical featuresIt is useful for both clinician and patient to standardise the terms used in CH. A cluster headache or an attack is an individual episode of pain that can last from a few minutes to some hours. A cluster bout or period refers to the duration over which recurrent cluster attacks are occurring; it usually lasts some weeks or months. A remission is the pain-free period between two cluster bouts. CH is a disorder with highly distinctive clinical features. These features are dealt with under two headings: the cluster attack and the cluster bout. The cluster attackThe attacks are strictly unilateral, though the headache may alternate sides. The pain is excruciatingly severe. It is located mainly around the orbital and temporal regions though any part of the head can be affected. The headache usually lasts 45-90 minutes but can range from 15 minutes to three hours. It has an abrupt onset and cessation....

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Cluster Headache Attacks Treated for Up Three Months with Subcutaneous Sumatriptan (6 mg)

Cited by 104 publications

References 8 publications

Tissue Injury Regulates Serotonin 1D Receptor Expression: Implications for the Control of Migraine and Inflammatory Pain

Tissue Injury Regulates Serotonin 1D Receptor Expression: Implications for the Control of Migraine and Inflammatory Pain

Does repeated subcutaneous administration of sumatriptan produce an unfavorable evolution in cluster headache?

Trigeminal-Autonomic Cephalgias

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