Management of cluster headache.
Am Fam Physician. 2005 Feb 15;71(4):717-24.
Beck E, Sieber WJ, Trejo R.
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.

Cluster headache, an excruciating, unilateral headache usually accompanied by conjunctival injection and lacrimation, can occur episodically or chronically, and can be difficult to treat. Existing effective treatments may be underused because of underdiagnosis of the syndrome. Oxygen and sumatriptan have been demonstrated to be effective in the acute treatment of cluster headaches. Verapamil has been shown to be effective for prophylaxis. For cluster headache completely refractory to all treatments, surgical modalities and newer interventions such as the implantation of stereotactic electrodes may be useful. Patients should be encouraged to avoid possible triggers such as smoking or alcohol consumption, especially during the duster period. The intensity of duster headache pain leads to ethical concerns among researchers over the use of placebo, making randomized controlled trials difficult. As new technology and genetic studies clarify the etiology of duster headache, it is possible that more specific therapies will emerge.

Effects of a fast disintegrating/rapid release oral formulation of sumatriptan on functional ability in patients with migraine.
Curr Med Res Opin. 2004 Dec;20(12):2021-9.
Barbanti P, Carpay JA, Kwong WJ, Ahmad F, Boswell D.
Department of Neurological Sciences, La Sapienza University, Rome, Italy.

BACKGROUND: A new oral form of sumatriptan has been developed to facilitate tablet disintegration and drug dispersion and to mitigate the effects of gastric stasis that can accompany migraine. OBJECTIVE: To evaluate the effects on functional ability of the new fast disintegrating/rapid release formulation of sumatriptan. METHODS: Sumatriptan 50 mg (n = 137), 100 mg (n = 142), or placebo (n = 153) was administered early when pain was mild for the acute treatment of a single migraine attack in a randomized, double-blind, parallel-group, placebo-controlled clinical trial. For this report, main health-outcomes endpoints (which were secondary endpoints for this clinical trial that was primarily designed to assess pain-free efficacy) included functional ability measured through 2 h postdose on a 5-point scale and lost time equivalents, a composite measure of migraine-associated time missed from activities, and reduced effectiveness at activities through 24 h postdose. RESULTS: Normal functional ability was restored in a significantly (p < 0.05) greater percentage of patients treated with sumatriptan than placebo beginning 45 min postdose for sumatriptan 100 mg and 1 h postdose for sumatriptan 50 mg. During the 24 h after initial dosing, the median (range) lost time equivalents for the combination of paid work activities and activities outside of paid work were significantly lower in the groups treated with sumatriptan (1.1 [0-10] sumatriptan 100 mg; 0.8 [0-36] sumatriptan 50 mg) compared with placebo (2.9 [0-24]) (p < or = 0.01 each sumatriptan group versus placebo). The corresponding mean +/- SD values for lost time equivalents were 1.9 +/- 2.3 and 2.5 +/- 4.7 for sumatriptan 100 mg and 50 mg, respectively, compared with 3.5 +/- 4.3 for placebo. CONCLUSION: A new oral sumatriptan formulation confers rapid, sustained restoration of functional ability in the acute treatment of migraine so that patients can return rapidly to normal functioning at work and outside of work.

Migraine: diagnosis and management.
Intern Med J. 2003 Sep-Oct;33(9-10):436-42.
Goadsby PJ.
Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.

Migraine is the most common form of disabling primary headache and affects approximately 12% of studied Caucasian populations. Non-pharmacological management of migraine largely consists of lifestyle advice to help sufferers avoid situations in which attacks will be triggered. Preventive treatments for migraine should usually be considered on the basis of attack frequency, particularly its trend to change with time, and tract-ability to acute care. Acute care treatments for migraine can be divided into non-specific treatments (general analgesics, such as aspirin or non-steroidal anti--inflammatory drugs) and treatments relatively specific to migraine (ergotamine and the triptans). The triptans--sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan and frovatriptan--are potent serotonin, 5-HT1B/1D, receptor agonists which represent a major advance in the treatment of acute migraine. Chronic daily headache in association with analgesic overuse is probably the major avoidable cause of headache disability in the developed world.

Headache 2002 Jan;42 Suppl 1:10-7
Clinical benefits of early triptan therapy for migraine.
Pascual J.
Department of Neurology, Hospital Universitario Marques de Valdecilla, Santander, Spain.

Although triptans have been proven effective for acute treatment of migraine, reserving them for moderate or severe pain may produce suboptimal pain relief and higher rates of recurrence. Recent evidence indicates that early intervention at the onset of pain improves outcomes. Post hoc analysis of a long-term, open-label European study of almotriptan 12.5 mg found that the percentage of attacks rendered pain-free at 2 hours was significantly greater when patients treated mild pain (84%) than when the intervention occurred during moderate or severe pain (53%). A similar pattern emerged with respect to the consistency of pain relief, with a significant advantage for early intervention (88% versus 56%, respectively). A difference in favor of early intervention was also seen with respect to recurrence, need for rescue medication, and adverse events. The recurrence rate was significantly lower in patients treating mild pain (28%) than in those delaying treatment until the pain became moderate or severe (33%), which suggests that achieving pain freedom results in less recurrence. These results were generally replicated in post hoc analysis of a subgroup of patients from a randomized, placebo-controlled trial (the Spectrum Study) of oral sumatriptan 50 mg in migraineurs. This analysis demonstrated that with early intervention, pain was less likely to intensify, fewer attacks required redosing, more attacks remained pain-free 24 hours postdose, and normal function returned more quickly. In sum, early intervention with triptans can improve outcomes, avoiding much of the pain and disability associated with treating moderate or severe attacks.

Drug information

GENERIC NAME: sumatriptan
BRAND NAME: Imigran, Imitrex

DRUG CLASS AND MECHANISM: Sumatriptan is an antimigraine medicine. Migraine headaches are believed to result from dilatation of the blood vessels in the head. Sumatriptan causes constriction of the blood vessels, thus relieving migraine headache. While it is very effective in relieving migraine, it does not prevent or reduce the number of attacks of migraine.

PREPARATIONS: The medication can be administered orally or by injection. Tablets: (25mg, 50mg). Injection: (6mg).

STORAGE: Should be stored at room temperature, away from heat and light. Keep your medicine away from the reach of children.

PRESCRIBED FOR: Sumatriptan is used to relieve migraine and its associated nausea and light sensitivity. It does not prevent or reduce the number of attacks of migraine. It should not be used to treat other types of headaches.

DOSING: May be taken with or without food.

DRUG INTERACTIONS: Sumatriptan is metabolized mainly by the liver and dosages may need to be reduced in patients with liver dysfunction. Sumatriptan can cause elevation of blood pressure and spasm of the coronary arteries of the heart. Sumatriptan should be avoided by patients with coronary artery disease (patients with angina pectoris and a history of heart attacks), and by patients with poorly controlled high blood pressure. It is administered with caution to patients with risk factors for coronary artery disease ( high blood pressure, diabetes, elevated blood cholesterol, obesity, cigarette smoking, and strong family history of heart attacks). In some patients, the first dose of sumatriptan can be given in the physician's office to monitor any adverse heart events.

Sumatriptan should not be administered along with ergot type migraine medications, or with MAO inhibitors. Sumatriptan and ergotamine together can cause prolonged spasm of the blood vessels. Therefore, the use of these two medications should be separated by at least 24 hours. Safe use in children has not been established. Rarely, seizures after sumatriptan administration have been reported in patients with epilepsy.

PREGNANCY: Safe use in pregnancy has not been established.

NURSING MOTHERS: Safe use in nursing mothers has not been established.

SIDE EFFECTS: For many migraine sufferers sumatriptan, appropriately used, has been a valuable and effective treatment in aborting attacks. Side effects are generally transient. Some common side effects include pain or tightness in the chest or throat, tingling, flushing, weakness, dizziness, abdominal discomfort, and sweating. Rarely, allergic reactions (even anaphylaxis) have been reported, usually in individuals who are highly allergic to multiple allergens.

Caution! Before starting to take this medicine, it is vital that you should consult your doctor! Do not use it on your own initiative, without medical advice.
Also, you should read carefully important health information about this drug given here:

www.nlm.nih.gov

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IMIGRAN (IMITREX)
Generic name: Sumatriptan succinate
Manufacturer: Glaxo Wellcome (UK)

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Dosage	Packing	Price	Pay now
50 mg	6 tab	USD 66.00
100 mg	6 tab	USD 107.00