Headaches: Cluster - Highlights

Highlights

FDA Warning: Serotonin Syndrome

In 2006, the FDA issued a warning against using triptan drugs and certain antidepressant medications at the same time. Combining a triptan with a selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine reuptake inhibitor (SSRI) can result in serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excess levels of the brain chemical serotonin.

• The FDA’s warning names the following antidepressants: Citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluvoxamine (Luvox), fluoxetine (Prozac), olanzapine fluoxetine combination (Symbax), sertraline (Zoloft), fluvoxamine, duloxetine (Cymbalta), venlafaxine (Effexor).
• If you are currently taking a triptan and antidepressant, talk to your doctor before stopping your medications.
• Serotonin syndrome symptoms include restlessness, hallucinations, rapid heartbeat, tremors, increased body temperature, diarrhea, nausea, and vomiting. Seek immediate medical care if you experience these symptoms.

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Characteristics of Cluster Headaches

Cluster headaches are the most painful of all headaches. According to a 2006 study in the journal Headache, patients with cluster headaches also experience during attacks:

• Nausea and vomiting (28%)
• Intolerance to light or sound (61%)
• Restlessness during attacks (68%)
• Migraine-like aura before attack (23%)

Lifestyle Factors

Smoking and alcohol use are associated with cluster headaches. In the Headache study, 66% of patients were current smokers. About half reported that alcohol, usually red wine, was a trigger for the attacks.

Management of Cluster Headaches

• Treatment. Triptan drugs or oxygen therapy can provide quick pain relief and are the main ways to treat a headache attack. Sumaptriptan (Imitrex) injection is most commonly used triptan. A 2006 study in the Archives of Neurology suggested that zolmitriptan (Zomig) nasal spray also works well for cluster headache pain relief.
• Prevention. The high blood pressure medication verapamil (Calan) and corticosteroid drugs such as prednisone are the medications most commonly used to prevent cluster headaches.

Review Date: 10/19/2006
Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital