Table of Contents
- Highlights
- Introduction
- Cluster Headaches
- Causes
- Prognosis
- Risk Factors
- Symptoms
- Diagnosis
- Managing Cluster Headaches
- Treatment for Acute Attacks
- Preventive Medications
- Surgery
- Resources
- References
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.
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.
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.
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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)
