Headaches: Cluster - Treatment

Highlights	Risk Factors	Surgery
Introduction	Diagnosis	Resources
Cluster Headaches	Managing Cluster Headaches	References
Causes	Treatment
Prognosis	Medications

Treatment

Breathing pure oxygen (by face mask, for 15 minutes or less) is one of the most effective and safest treatments for cluster headaches. It is often the first choice. Inhalation of oxygen raises blood oxygen levels and therefore relaxes constricted blood vessels. Between 57% to 93% of patients with episodic cluster headaches have found it to be beneficial. About half of those with chronic cluster headaches response to oxygen treatment. It should be noted that pure oxygen can be toxic to the lungs when used for long durations.

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Triptans

Triptans are migraine agents that are proving to have an important role in stopping a cluster attack. Injections of sumatriptan (Imitrex) are the standard triptan treatment. Sumatriptan injections are effective within 15 minutes in about three fourths of cluster attacks. The nasal spray form is also proving to be effective, though for some people it does not work as well as the injectable form. The nasal spray is most beneficial for attacks that last at least 45 minutes. Other triptans being studies for cluster headache include rizatriptan (Maxalt), naratriptan (Naramig, Amerge), and zolmitriptan (Zomig).

Side Effects. Many of the newer triptans may have fewer severe side effects than sumatriptan. Side effects of most triptans, however, can include the following:

Nausea.
Dizziness.
Muscle weakness.
Heaviness, pain or both in the chest. (About 40% of patients taking sumatriptan experience these symptoms and they are major factors in discontinuing the drug. Newer agents may produce fewer chest symptoms.)
Tingling and numbness in the toes.
Rapid heart rate.
Other effects include a warm sensation and discomfort in the ear, nose, and throat.

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

Complications on the Heart and Circulation. Triptans narrow (constrict) blood vessels. Because of this effect, very rarely spasms in the blood vessels may occur and cause serious side effects, including stroke and heart attack. Such events are not only rare but occur primarily in patients with an existing history or risk factors for these conditions.
Serotonin Syndrome. Triptans also affect serotonin and so people taking antidepressants that increase serotonin levels (which are most antidepressants) should avoid taking both. The effects of such combinations may cause a so-called serotonin syndrome, which causes mental changes, restlessness, tremor, chills, sweating, and colitis. Some doctors believe, however, that the risk for the syndrome from taking both classes of drugs is very small.