عندما يفشل السوماتريبتان تحت الجلد أو الأكسجين عالي التدفق في الصداع العنقودي المزمن مع الهجمات اليومية

References

DOI: 10.1111/ene.15956

In patients suffering from the less common chronic presentation (<20% of cluster headaches, ICHD-3 3.1.2), attacks often occur on a daily basis; if symptom-free periods are experienced, these last <3 months, for at least 1 year.

An alternative would be zolmitriptan (5 mg) or sumatriptan (20 mg) nasal spray, with the disadvantage of a slower onset than with injected sumatriptan.

Weak recommendations based on consensus further include DHE nasal spray and lidocaine.

Nasal instillation into the ipsilateral nostril of 1 mL 4%-10% lidocaine solution with the patient positioned reclining 45 and 30-40 rotation toward the symptomatic side has been recommended for the reduction of acute symptoms.

Headache relief at 30 min was observed in 63% of patients treated with 10 mg of zolmitriptan (application into the contralateral nostril is recommended) compared with 48% treated with 5 mg of zolmitriptan and 30% treated with placebo.