Preventive treatment with ergotamine plus lasmiditan for chronic cluster headache after failure/intolerance of standard therapies: A case report

Aim Although ergotamine is administered before bedtime as a preventive therapy, recent studies have suggested that morning administration is more effective. Lasmiditan, a selective 5-HT 1F receptor agonist, does not have vasoconstrictive properties and can be used in combination with ergotamine or triptan. A combination therapy with ergotamine and lasmiditan may be effective as a preventive strategy for patients with cluster headache who do not respond to standard treatment. Methods We report a case of a 27-year-old man with chronic cluster headache who experienced chest tightness and palpitations after subcutaneous sumatriptan and showed an inadequate response to verapamil, lithium, topiramate, and galcanezumab. Oxygen therapy was only partially effective, and short corticosteroid courses resulted in transient remission. We administered ergotamine (1 mg) in the morning and lasmiditan (100 mg) at bedtime. Results Within 7 days, the attack frequency declined from daily (3–4/day) to once every 3–4 days, and pain intensity decreased from NRS 8/10 to 3/10. Benefits persisted for over 3 months without reported adverse effects, enabling a return to full-time work. Conclusion This case demonstrates that a combination therapy with ergotamine and lasmiditan may be a preventive option for cluster headaches that are difficult to manage with standard treatment.