क्रोनिक क्लस्टर हेडेक वाले उन रोगियों में जिनके दौरे प्रतिदिन होते हैं — और जो मानक प्रथम-पंक्ति तीव्र उपचार पर 15 मिनट के भीतर पर्याप्त दर्द निवारण प्राप्त नहीं कर पाते — एक संरचित अगली-पंक्ति दृष्टिकोण संकेतित है।
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.
View source ↗