Headaches: Cluster - Medications

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Side Effects of Valproate and Other Anti-Seizure Drugs. The side effects given here are mostly associated with valproate. Other anti-seizure drugs have similar effects and some specific ones of their own. Most are usually minor, occurring early in therapy, and then subsiding. Those of valproate include:

• Gastrointestinal problems (nausea, vomiting, heartburn)
• Visual disturbances
• Ringing in the ear
• Hair loss
• Weight changes (weight gain is a significant problem with valproate, while weight loss occurs with topiramate)
• Agitation
• Odd movements
• In women, menstrual irregularities and a higher risk for polycystic ovary syndrome (PCOS)

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Very serious side effects are rare but include the following:

• Liver damage
• Convulsions
• Coma
• Pancreatitis (inflammation of pancreas) in adults and children
• Significant increase in risk for birth defects in pregnant women

Capsaicin

A nasal spray form of capsaicin called civamide (Zucapsaicin) has shown promise in the prevention and treatment of cluster headaches. Capsaicin is a component of hot red peppers that seems to reduce substance P, a chemical in the body that contributes to inflammation and the delivery of pain impulses. In a small 2002 study, daily use of intranasal civamide resulted in more than a 50% reduction in headaches. Side effects include a burning sensation and excessive tearing.

Transitional Drugs

Certain medications are useful as transitional drugs. These medications are used after cluster episodes to stabilize the patient until preventive maintenance becomes effective.

Methysergide. Methysergide (Sansert) is also used for preventing episodic cluster headaches. (It is not very effective for chronic cluster headaches.) Improvement usually occurs within a few days, although it may be delayed for up to 2 weeks. Prolonged methysergide therapy can cause serious side effects, including scarring of internal organs, so it cannot be used long term. This is not usually a problem for patients with cluster headaches, since they only require the drug for about 4 - 6 weeks. Nevertheless, patients should immediately report to their doctors any of the following symptoms: cold, numb, and painful hands and feet; leg cramps on walking; any type of back or chest pain.