It is possible to treat cluster headaches without vasoconstricting agents, say researchers from the Institute of Neurology (Queen Square), Hammersmith Hospital, and Charing Cross Hospital in London. In their study, 52% of 48 patients responded within 30 minutes to subcutaneous octreotide acetate (e.g., Sandostatin LAR®, Novartis), a somato-statin analogue. The researchers believe that this is the first placebo-controlled study to investigate the potential use of octreotide in treating acute cluster headaches.
The main side effect was short-lived and consisted of mild gastrointestinal upset in eight patients taking the study drug and in four patients taking placebo. This makes octreotide an attractive agent when repeated doses are needed over a relatively short period. Gallstones have been a concern with long-term octreotide treatment, but the risk is probably low.
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With regard to primary headache, another of their trials showed that octreotide had no effect on migraine despite research that had suggested a benefit. The researchers point to a marked difference between migraine and cluster headaches in the pattern of brain activation. For patients with cluster headache, the activity is in the posterior hypo-thalamus; for those with both episodic and chronic migraine, the brainstem is without hypothalamic activation. The researchers say that this is in keeping with a greater prominence of a somato-statinergic mechanism in cluster headache. If so, their study would be the first to offer substantial evidence for a pharmacologically based difference in the acute treatment of the two disorders, which are “strikingly clinically different.”
Their findings also offer hope to patients for whom 5-hydroxytryptamine agonists and oxygen do not work or as an alternative to oxygen for patients with cardiovascular disease.