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Treatment of Cluster Headache Attacks With Less Than 6 mg Subcutaneous Sumatriptan


  • Nora Gregor MD,

  • Christian Schlesiger MD,

  • Esra Akova-Öztürk MD,

  • Christoffer Kraemer MD,

  • Ingo-Wilhelm Husstedt MD,

  • Stefan Evers MD, PhD

  • From the Department of Neurology, University of Münster, Germany.

Address all correspondence to Dr. Stefan Evers, MD, PhD, Department of Neurology, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.


Background.—Subcutaneous (SQ) sumatriptan 6 mg is effective in the treatment of acute cluster headache attacks. However, patients sometimes benefit from a dose less than 6 mg.

Objective.—Therefore, we designed a prospective open study to evaluate how many patients benefit from a dose less than 6 mg SQ sumatriptan.

Methods.—We enrolled 81 consecutive patients with cluster headache and recorded their use of SQ sumatriptan and oxygen. Patients regularly using SQ sumatriptan 6 mg were advised to treat attacks with doses less than 6 mg and with oxygen. Efficacy and side effects of the different treatment options (6 mg, 3 mg, 2 mg, and oxygen) were evaluated.

Results.—As a result, 74% of the patients using SQ sumatriptan 3 mg showed efficacy and 89% reported efficacy after 2 mg. Seventy-nine percent reported side effects after the use of SQ sumatriptan 6 mg (29% severe side effects). After the use of 2 mg SQ sumatriptan, only 50% of the patients reported side effects, none of these were classified as severe. Patients' preference was 41% for 6 mg sumatriptan, 28% for doses less than 6 mg, and 31% for oxygen.

Conclusions.—We conclude that sumatriptan in doses less than 6 mg can be effective in the acute treatment of cluster headache attacks. We suggest that patients should have experience in their individual efficacy of sumatriptan doses less than 6 mg.