Headaches: Cluster - Medications

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Ergotamine

Injections of the ergotamine-derived drug known as dihydroergotamine (DHE, Migranal) can stop cluster attacks within 5 minutes in many patients, offering benefits similar to injectable sumatriptan. Ergotamine is also available in the form of a nasal spray, rectal suppositories, and tablets.

Ergotamine can have dangerous drug interactions with many medications, including sumatriptan. All ergotamine products approved by the Food and Drug Administration (FDA) contain a "black box" warning in the prescription label explaining these drug interactions. Because ergotamine constricts blood vessels, patients with peripheral vascular disease should not use this drug.

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Local Anesthetics

Lidocaine, a local anesthetic, may be useful in nasal-spray or nasal-drop form for stopping cluster attacks. Reports suggest that it is helpful for most patients within about 40 minutes. It can have an unpleasant taste. Some doctors recommend that patients try a topical application of lidocaine to see if it helps ease pain.

Capsaicin is a compound derived from hot pepper. Some patients who have not found relief through other medications use it to treat or prevent cluster headaches by applying it intranasally. There have been few studies to confirm its effectiveness. It can cause an intense burning sensation.

Review Date: 09/29/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).