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New Message Board Archives >> Medications, Treatments, Therapies 2005 >> Treatment summary -- from Italy
(Message started by: Bob_Johnson on Jan 11th, 2005, 7:56am)

Title: Treatment summary -- from Italy
Post by Bob_Johnson on Jan 11th, 2005, 7:56am
Neurol Sci. 2004 Oct;25 Suppl 3:S119-22.
 
Cluster headache: symptomatic treatment.

Torelli P, Manzoni GC.

Headache Centre, Section of Neurology, Department of Neuroscience, University of Parma, Via Gramsci 14, I-43100 Parma, Italy. paolatorelli@libero.it

The clinical management of cluster headache (CH) attacks requires a symptomatic treatment that is rapidly effective in resolving or significantly reducing symptoms. First-choice drugs for the symptomatic treatment of CH are subcutaneous sumatriptan at a dose of 6 mg and 100% oxygen inhalation at a rate of 7 l/min for no more than 15 min. Sumatriptan acts by suppressing pain and the accompanying autonomic phenomena, with no substantial differences in its mechanism of action between episodic and chronic CH. The drug can be used for prolonged periods without loss of efficacy or safety and its side-effects are generally mild or moderate. Oxygen inhalation has a number of advantages over drug therapy: it is free from side-effects, has no contraindications--unlike sumatriptan, it can be used in patients with cardiac, cerebral or peripheral vascular disease and with kidney, liver or lung disease--acts rapidly and can be administered several times a day. Its disadvantages are that it is scarcely practical and may induce a "rebound effect". Sumatriptan nasal spray, zolmitriptan and dihydroergotamine nasal spray are scarcely effective. After the introduction of sumatriptan, ergotamine tartrate has been relegated to a secondary role in the symptomatic treatment of CH. Among other non-drug and topical drug treatment options, hyperbaric oxygen therapy and the intranasal application of 10% cocaine hydrochloride and 10% lidocaine in the sphenopalatine fossa have also proved effective.

PMID: 15549518 [PubMed - indexed for MEDLINE]

Title: Re: Treatment summary -- from Italy
Post by JoeS on Jan 11th, 2005, 12:22pm

Quote:
intranasal application of 10% cocaine hydrochloride


Snorting coke?  Can I get a perscription for that?    [smiley=laugh.gif]

Title: Re: Treatment summary -- from Italy
Post by nani on Jan 11th, 2005, 12:29pm
I think they used to deliver coke that way (as recently as the early 80s) through a liquid cocaine soaked swab, left in the nostril for awhile. I remember a news story on a dr in NYC who treated a whole host of ailments with it. I remember seeing the comedian David Brenner was one of his patients.

Title: Re: Treatment summary -- from Italy
Post by Margi on Jan 11th, 2005, 12:35pm
Bob, isn't this the treatment that Ted had a few years ago?  The sphenopalatine block?  I'm pretty sure it was a mix of cocaine and lidocaine delivered this way that did bring him some temporary relief at the high point of one of his worst times ever.  I'm also quite sure it was done in his home state of MA, too.  

Title: Re: Treatment summary -- from Italy
Post by Bob_Johnson on Jan 12th, 2005, 7:21am
Margi, I don't recall. I suspect that if this cocaine swab approach isn't being used it may be because docs are concerned about getting involved with such a drug rather than that the treatment isn't effective.

Perhaps Italians can teach us something.... <bg>

Title: Re: Treatment summary -- from Italy
Post by karma on Jan 12th, 2005, 8:13am
Questionable


Quote:
SumatriptanThe drug can be used for prolonged periods without loss of efficacy or safety and its side-effects are generally mild or moderate.
unlike sumatriptan, it can be used in patients with cardiac, cerebral or peripheral vascular disease and with kidney, liver or lung disease--

100% oxygen inhalation at a rate of 7 l/min

Sumatriptan nasal spray, zolmitriptan and dihydroergotamine nasal spray are scarcely effective.

Title: Re: Treatment summary -- from Italy
Post by Bob P on Jan 12th, 2005, 9:45am
7 lpm O2 works quite well for me.  Never ran it higher than 8 lpm.

I've seen lots of articles saying trex doesn't lose it's efficacy.  One study in the OUCH Library speaks of patients using it multiple times a day for a year with no problems, lose of efficacy or rebounds.

I used the lidocaine nasal spray a couple of clusters ago.  It gave marginal relief if any.  It has a short shelf life so you usually have to find a pharmacy that will mix it up for you.



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