Headaches: Cluster - Medications

Treatment for Acute Attacks

Oxygen Therapy

Breathing pure oxygen (by face mask, for 15 minutes or less) is one of the most effective and safest treatments for cluster headache attacks. It is often the first choice treatment. Inhalation of oxygen raises blood oxygen levels, therefore relaxing narrowed blood vessels.

Triptans

Triptans are drugs that are usually used to treat migraine headaches. They can also help stop a cluster attack. An Injection of sumatriptan (Imitrex) is the standard triptan treatment and is FDA-approved for cluster headaches. Sumatriptan injections work within 15 minutes in about three quarters of most cluster attacks. The nasal spray form may also be effective for some patients, and generally provides relief within 30 minutes. The spray seems to work best for attacks that last at least 45 minutes, although some people find it does not work as well as the injectable form.

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Zolmitriptan (Zomig) is another triptan drug used for cluster headache treatment. It is given in either oral or nasal spray form. Zolmitriptan may have fewer side effects than sumatriptan.

Side Effects. Side effects of sumatriptan may include:

• Nausea
• Dizziness
• Muscle weakness
• Heaviness or pressure in the chest
• Tingling and numbness in the toes
• Rapid heart rate

Complications and Contraindications of Triptans. The following are potentially serious problems with triptans:

• Complications on the Heart and Circulation. Triptans narrow (constrict) blood vessels. Because of this action, spasms in the blood vessels may occur, which can cause stroke and heart attack. This is a rare but very serious side effect. Patients with a history of heart attack, stroke, angina, uncontrolled high blood pressure, peripheral artery disease, or heart disease should not use triptan drugs.
• Serotonin Syndrome. Serotonin syndrome is a life-threatening condition that occurs from an excess of the brain chemical serotonin. Triptans, as well as certain types of antidepressant medications, can increase serotonin levels. These antidepressant drugs include serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor). It is very important that patients not combine a triptan drug with an SSRI or SNRI drug. Serotonin syndrome is most likely to occur when starting or increasing the dose of a triptan or antidepressant drug. Symptoms include restlessness, hallucinations, rapid heartbeat, tremors, increased body temperature, diarrhea, nausea, and vomiting. You should seek immediate medical care if you have these symptoms.