Thoughts on what we expect from treatments.

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Posted by Bob Johnson ( on July 18, 2000 at 11:15:12:

This interesting report involves so few patients that we should not make judgments about the use of sumatriptan based on it alone. It did, however, trigger off some thoughts about the struggle to find effective treatments and how our state of mind is affected by this quest.

Sumatriptan has had wonderful press here and in the medical literature. The danger is that we come to regard it as a "magic bullet" and not understanding that, as this article reports, it might actually cause us more pain and, as an increasing number of reports indicate, that can lead to rebound headaches.

So many messages express a desperate seeking for relief from CH that I'm always concerned about folks who try something without knowledge and/or have excessive expecations which lead to a sense of failure, futility, and distress when the expectation isn't met. The old pioneer, Dr. Seymour Diamond has observed that, for example, preventive medications are considered successful if they reduce the severity or prevent CH about 60-70% of the time. Expecting perfect relief will produce feelings of failure, etc.

After reading medical literature for some years on CH I've seen several patterns:

1. Treatments come and go; they are often presented as experiments worth trying but nothing is a guarantee.
2. Medicines may work for us for a time and then stop being effective. Why this is so is unknown--but it does require that we be open to the need to start another round of trials to find an alternative. But I think that "intelligent selfishness" suggests we go through these experiences, as frustrating as they are, without shaking our fist at the heavens!
3. Living the best we can with the best we can find IS success.

Or, as Riccardo will understand, "Amegliare forse, ma curare mai."


1: Headache 2000 Jan;40(1):41-4

Alteration in nature of cluster headache during subcutaneous administration of sumatriptan.

Hering-Hanit R

Headache Unit, Department of Neurology, Meir General Hospital, Kfar Sava, and the Sackler Faculty of Medicine, Tel Aviv University, Israel.

[Medline record in process]

OBJECTIVES: To document the relationship between the 5-HT receptor agonist sumatriptan and a change in the nature of cluster headache in four cases. To relate the findings to the literature on the use of sumatriptan in both cluster headache and migraine. BACKGROUND: Studies of the efficacy and adverse effects of long-term treatment with sumatriptan in cluster headache are limited and report conflicting findings. METHODS: Four cases are described. RESULTS: All four patients developed a marked increase in the frequency of attacks 3 to 4 weeks after initiating treatment with the drug for the first time. Three patients also developed a change in headache character, and 2 experienced prolongation of the cluster headache period. Withdrawal of the drug reduced the frequency of headaches and eliminated the newly developed type of headache. CONCLUSIONS: Determination of the effects of long-term use of sumatriptan will result in more precise guidelines for the frequency and duration of treatment with this otherwise extremely beneficial drug.

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