Introduction

Subcutaneous sumatriptan, a 5HT_1B/1D agonist, is the most effective drug in cluster headache acute treatment. About 25% of the patients do not respond to subcutaneous sumatriptan; the reasons for this are unknown. In this study, we compare clinical characteristics of cluster headache patients responding and non-responding to subcutaneous sumatriptan.

Methods

We retrospectively investigated the clinical records of 277 cluster headache patients. Patients reporting repeated satisfactory response to subcutaneous sumatriptan within 15 minutes were considered responders.

Results

Of 206 cluster headache patients who had used subcutaneous sumatriptan (mean age 45.6, 16% females, 48% chronic), 91% were responders, and 9% non-responders. Compared to responders, non-responders had longer and more frequent attacks: 60 (median; IQR 38–90) vs. 100 (60–120) minutes (p = 0.028), 4 (2.5–5) vs. 3 (2–4) attacks/day (p = 0.024). No other difference was found.

Conclusions

In cluster headache attacks with long duration and high frequency, pain mechanisms not involving 5HT_1B/1D receptors may play a more relevant role.

中文翻译：

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对舒马曲坦无反应的丛集性头痛：一项回顾性研究。

介绍

皮下注射舒马曲坦是一种 5HT _1B/1D激动剂，是治疗丛集性头痛急性期最有效的药物。大约 25% 的患者对皮下注射舒马曲坦没有反应；原因不明。在这项研究中，我们比较了对皮下注射舒马曲坦有反应和无反应的丛集性头痛患者的临床特征。

方法

我们回顾性调查了 277 名丛集性头痛患者的临床记录。在 15 分钟内报告对皮下注射舒马曲坦重复满意反应的患者被认为是反应者。

结果

206 名使用过皮下注射舒马曲坦的丛集性头痛患者（平均年龄 45.6 岁，16% 女性，48% 慢性），91% 有反应，9% 无反应。与有反应者相比，无反应者的发作时间更长且频率更高：60（中位数；IQR 38-90）与 100（60-120）分钟（p  = 0.028）、4（2.5-5）与 3（2- ）分钟4) 攻击次数/天 ( p  = 0.024)。没有发现其他差异。

结论

在持续时间长、频率高的丛集性头痛发作中，不涉及 5HT _1B/1D受体的疼痛机制可能发挥更相关的作用。