Headaches: Cluster - Treatment

The following groups should avoid triptans or take them with caution and onlyunder doctor supervision:

Anyone with a history or with any risk factors for stroke, uncontrolled diabetes, high blood pressure, or heart disease.
People taking antidepressants that increase serotonin levels.
Pregnant women. Studies on the effects of triptans in this group are limited. One study suggested a higher incidence of preterm deliveries in pregnant women taking sumatriptan. No higher rates of still births or birth defects were reported. In general, pregnant women should avoid any medications if possible.

Ergotamine

Injections of the ergotamine-derived drug known as dihydroergotamine (DHE) have stopped cluster attacks within five minutes in many patients, offering benefits similar to injectable sumatriptan. Ergotamine aerosols or ergotamine suppositories with caffeine may also be useful. When using the aerosol the patient usually inhales two or three times. They should be sure to shake the canister vigorously and administer the spray while making an inhalation immediately after a forced exhalation. The patient should then hold the breath for several seconds before slowly exhaling. Proper administration can produce an effective response 80% of the time. (Oral and under-the-tongue preparations of ergotamine are ineffective because of the brevity of cluster attacks.)

Local Anesthetics

Lidocaine, a local anesthetic, may be useful in nasal-spray or nasal-drop form for aborting cluster attacks. Some reports suggest that it is helpful for most patients within about 40 minutes.