It's nothing earth-shattering to any of us, but my Dr. sent me a link to a new article article in Neurology. It is a meta-analysis of already-know treatment.  I'll see if I can get the whole article tomorrow when I'm linked into the medical school network at work.

Anyone using intranasal civamide 100 microg as a preventative?

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Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology. 2010 Aug 3;75(5):463-73. (Review) PMID: 20679639 

CH-free, still, since the first of August! A couple of minor migraines, but it has been an awesome two months with almost no pain!

Jim

Spraying capsaicin (aka Civamide, aka the hot stuff in hot peppers) sounds painful in itself.  THis is a preventative they're talking about. Next go-aroung, I might be willing.  Oxygen and sumiptriptan shots are still my best buddies.
Jim

Jim L wrote on Oct 10^th, 2010 at 9:23pm:

Spraying capsaicin (aka Civamide, aka the hot stuff in hot peppers) sounds painful in itself.  THis is a preventative they're talking about.

I never say never....but that wouldn't be on the top of my list of things to try.


Quote:

CH-free, still, since the first of August! A couple of minor migraines, but it has been an awesome two months with almost no pain!

Now that's some good news!

I just took a quick look at PuMed and found so little being published on this drug that it suggests that folks in the trenches are not find much benefit in it.

Not an argument for not trying it but after the more established treatments have been tried & failed.

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Dr. Tamara Pringsheim
Source & CV: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

George J. Francis, Werner J. Becker und Tamara M. Pringsheim from the University of Calgary checked START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE and START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE for scientific publications about cluster headache treatment between 1950 and 2010. They found 1569 publications. 27 of them were prospective, double blind, randomised RCTs, matching the following criteria:


Quote:

1.  Headache response at 15 or 30 minutes, defined as a reduction in headache from moderate, severe, or very severe to mild or no pain (symptomatic trials) 2.  Pain-free response at 15 or 30 minutes (symptomatic trials) 3.  Cessation of CH attacks within a specific time period (preventive trials) 4.  Number of days on which a CH attack occurred (preventive trials)

Surgical treatments were not considered in this evaluation. The American Academy of Neurology quality criteria were used to assess trial quality and to grade advisements. Based on the evidence, for acute treatment of CH, Level A advice can be given for subcutaneous sumatriptan 6 mg, zolmitriptan nasal spray 5 mg and 10 mg, and 100% oxygen 6-12 L/min. Level B advice can be given for sumatriptan nasal spray 20 mg and oral zolmitriptan 5 mg and 10 mg.

For the prevention of CH, Level B advice can be given for intranasal civamide 100 microg daily and suboccipital steroid injections, and Level C advice can be given for verapamil 360 mg, lithium 900 mg, and melatonin 10 mg.

Nobody has said, that civamide works better than verapamil, lithium etc. The result of the evaluation simply says that there is no good study to prove that verapamil, lithium etc. work well for CH.


Source: Francis GJ, Becker WJ, Pringsheim TM (August 2010). "Acute and preventive pharmacologic treatment of cluster headache". Neurology 75 (5): 463–73. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

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including

American Academy of Neurology Quality Criteria (MS-Word, Free full text)   START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

American Academy of Neurology Classification of Recommendations (MS-Word, Free full text)   START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

27 of them were prospective, double blind, randomised RCTs

In 60 years.

Pretty damn pathetic.


Bob

Quote:

Spraying capsaicin (aka Civamide, aka the hot stuff in hot peppers) sounds painful in itself.

Exactly.  That's the supposed method by which it works.  It depletes the substance P dealing with the pepper pain so there is no substance P to enhance the pain of the CH.

Bob P wrote on Oct 13^th, 2010 at 8:10am:

Exactly.  That's the supposed method by which it works.  It depletes the substance P dealing with the pepper pain so there is no substance P to enhance the pain of the CH.

Reminds me of a father telling his son to stop crying: "I'll give you something to cry about."

Pinkfloyd wrote on Oct 12^th, 2010 at 10:29pm:

27 of them were prospective, double blind, randomised RCTs In 60 years. Pretty damn pathetic. Bob

It’s even worse.  :'( In the 14 included studies for preventive treatment there are only four studies rated “Class I” acc. to the American Academy of Neurology (AAN) Quality Criteria. Two of these four “Class I” studies had negative results.

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Summary of advisements for preventive treatment of cluster headache Civamide Direct evidence that civamide 100 µL is effective in improving headache response in CH. Nonserious adverse events: nasal burning, lacrimation, pharyngitis, rhinorrhea. One randomized, controlled clinical trial; AAN Class I Level B: should be considered for the prevention of CH Suboccipital steroid injection Direct evidence that long- and rapid-acting steroids 2.5 mL are effective in improving headache response in CH. Nonserious adverse event: transient injection site pain. One randomized, controlled clinical trial; AAN Class I Level B: should be considered for the prevention of CH Sodium valproate Direct evidence that sodium valproate 500 mg is not effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class I Level B: not advised for the prevention of CH Sumatriptan Direct evidence that sumatriptan 100 mg is not effective in improving headache response in CH. Nonserious adverse events: nausea, vomiting, headache, malaise. One randomized, controlled clinical trial; AAN Class I Level B: not advised for the prevention of CH Melatonin Evidence that melatonin 10 mg is effective in improving headache response in CH. Nonserious adverse events: none reported. One randomized, controlled clinical trial; AAN Class II Level C: may be considered for the prevention of CH Verapamil Evidence that verapamil 360 mg is effective in improving headache response in CH. Nonserious adverse events: constipation, reduced blood pressure, reduced heart rate. Two randomized, controlled clinical trials; 1 AAN Class II, 1 AAN Class III Level C: may be considered for the prevention of CH Cimetidine/chlorpheniramine Evidence that cimetidine 2,000 mg and chlorpheniramine 20 mg are not effective in improving headache response in CH. Nonserious adverse events: transient, erythematous skin rash. Other adverse events not reported. Two randomized, controlled clinical trials; 2 AAN Class II Level C: not advised for the prevention of CH Lithium Evidence that lithium 900 mg is effective in improving headache response in CH. Nonserious adverse event: polyuria. Two randomized, controlled clinical trials; 2 AAN Class II Level C: may be considered for the prevention of CH Misoprostol Evidence that misoprostol 300  g is not effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class II Level C: not advised for the prevention of CH Oxygen Evidence that 100% hyperbaric oxygen is not effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class II Level C: not advised for the prevention of CH Capsaicin Insufficient evidence that capsaicin is effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class III Level U: insufficient evidence to advise for the prevention of CH Nitrate tolerance Insufficient evidence that nitrate tolerance via 5-ISMN 30 mg is effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class III Level U: insufficient evidence to advise for the prevention of CH Prednisone Insufficient evidence that prednisone 20 mg every other day is effective in improving headache response in CH. Adverse events not reported. One randomized, controlled clinical trial; AAN Class III Level U: insufficient evidence to advise for the prevention of CH Source: Francis GJ, Becker WJ, Pringsheim TM (August 2010). "Acute and preventive pharmacologic treatment of cluster headache". Neurology 75 (5): 463–73. Table 4. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

In the group for the acute abortive treatment of cluster headache there were eight studies rated “Class I” acc. to the American Academy of Neurology Quality Criteria.