triptans for cluster headaches

17 Sep

nice review in a 2011 Annals:

N ~= 200s for each

 

Sumatriptan 6mg SQ

  • time to headache relief: 15 min
  • NNT = 2

 

Zolmitriptan 10mg intranasal

  • time to headache relief: 30 min
  • NNT = 3

 

QUICK TRIPTAN REVIEW:

Triptans are agonists at 5-HT1B and 5-HT1D receptors.

 desired therapeutic effect is cephalic vasoconstriction, but adverse effects are related to systemic vasoconstriction, such as:

  • CVAs,
  • MI,
  • vascular infarctions (e.g. ischemic colitis)
  • dysrhythmias,
  • etc.

so…DON’T give these to people with big cardiac risk factors, history of MI’s, etc.

 

ANOTHER COMMON TREATMENT OPTION:

High flow 02 (6-12 L/min) for > 15 min

  • NNT = 2
  • cheap, low side effect profile
  • consider co-administering with triptan (or solo)

 

References: the synopsis article; the cochrane review; an old post on triptans; picture

 

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