The Effect of Zonisamide in Prophylaxis Therapy in Episodic and Chronic Cluster Headache

The prophylactic therapy of the episodic (ECH) and chronic cluster headache (CCH) is based on verapamil and carbolithium. Besides several patients are not responders at this drugs. To evaluate the efficacy and tolerability of zonisamide in prophylaxis therapy of ECH and CCH. 11 patients (pz), (4 F,7 M) mean age 42.8 years (SD 5.8), range 36-56 years, suffering from ECH (8pz) and CCH (3 pz) (ICDH ’04 criteria) were studied. In all patients with ECH prophylaxis therapy with verapamil, carbolithium and valproic acid was failed in the past and patients with CCH continued therapy with carbolithium (2 pz) and verapamil (1 pz). During the three months evaluation period zonisamide was administered (starting dose 25mg/die, target dose 100 mg/die). In patients with ECH the basal frequency of attack/days and 1, 2, 3 months respectively was 4.2 (SD 1.9): 2.4 (SD 0.9), 1.6 (SD 0.9), 0.8 (SD 1.1) [P<0.0001]. In patients with chronic CH the basal frequency of attack/days and 1, 3, 6 months respectively was 2 (SD 0.8): 0.2 (SD 0.08), 0.06 (SD 0.04), 0.01 (SD 0.01) [P<0.05] (T-test analysis). In all patients zonisamide was well tolerated (5 patients complained somnolence, lack of concentration, vertigo and nausea but not withdrew the study). These data showed a good efficacy in reduction of frequency of attacks. Still, the drug is tolerable, in fact none patients withdrew the study. Our study suggests that zonisamide could be an alternative or complementary prophylaxis therapy for ECH and CCH.