Sodium oxybate for cluster headache prevention- The new kid on the block?
GAUTAMGANGULY, Physician, Neurology Consultants Medical Group[email protected]
Submitted August 23, 2011
I read with great interest the article written by Khatami et al. [1] along with the accompanying editorial by Silberstein and Robbins. Both these articles raise some clinical concerns. Obstructive sleep apnea is prevalent in patients with cluster headache to a range of 30%.[2,4,5]
The major limitation of the study was the small study size and none of the patients in the study had any sleep-disordered breathing. However, like sedative hypnotics with significant central nervous system depressant action [3], sodium oxybate has the potential to worsen obstructive sleep apnea. Cluster headache patients need to be screened for sleep-disordered breathing before starting the sodium oxybate to avoid worsening of this potential life threatening condition when untreated.
This was a small observational study showing some efficacy of sodium oxybate in preventing cluster headache attacks but a larger prospective, double-blinded study is warranted before any definite conclusions can be reached regarding the safety and efficacy of this medication that has a high abuse potential.
References
1. Khatami R, Tartarotti S, Siccoli MM, Bassetti CL, Sandor PS. Long term efficacy of sodium oxybate in 4 patients with chronic cluster headache. Neurology 2011; 77:67-70.
2. Kudrow L, Mcginty DJ, Phillips ER, Stevenson M. Sleep apnea in cluster headache. Cephalgia 1984; 4: 33-38.
3. Guilleminault C. Benzodiazepines, breathing and sleep. The American Journal Of Medicine 1990; 88:3: S25-S28.
4. Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM. Sleep disordered breathing in patients with cluster headache. Neurology 2000;54: 2302-2306.
5. Graff-Radford SB, Newman A. Obstructive Sleep Apnea and Cluster Headache. Headache 2004; 44: 607-610.
I read with great interest the article written by Khatami et al. [1] along with the accompanying editorial by Silberstein and Robbins. Both these articles raise some clinical concerns. Obstructive sleep apnea is prevalent in patients with cluster headache to a range of 30%.[2,4,5]
The major limitation of the study was the small study size and none of the patients in the study had any sleep-disordered breathing. However, like sedative hypnotics with significant central nervous system depressant action [3], sodium oxybate has the potential to worsen obstructive sleep apnea. Cluster headache patients need to be screened for sleep-disordered breathing before starting the sodium oxybate to avoid worsening of this potential life threatening condition when untreated.
This was a small observational study showing some efficacy of sodium oxybate in preventing cluster headache attacks but a larger prospective, double-blinded study is warranted before any definite conclusions can be reached regarding the safety and efficacy of this medication that has a high abuse potential.
References
1. Khatami R, Tartarotti S, Siccoli MM, Bassetti CL, Sandor PS. Long term efficacy of sodium oxybate in 4 patients with chronic cluster headache. Neurology 2011; 77:67-70.
2. Kudrow L, Mcginty DJ, Phillips ER, Stevenson M. Sleep apnea in cluster headache. Cephalgia 1984; 4: 33-38.
3. Guilleminault C. Benzodiazepines, breathing and sleep. The American Journal Of Medicine 1990; 88:3: S25-S28.
4. Chervin RD, Zallek SN, Lin X, Hall JM, Sharma N, Hedger KM. Sleep disordered breathing in patients with cluster headache. Neurology 2000;54: 2302-2306.
5. Graff-Radford SB, Newman A. Obstructive Sleep Apnea and Cluster Headache. Headache 2004; 44: 607-610.