The goal of abortive therapy for cluster headache is fast, effective and consistent relief. Because a cluster headache is relatively short in duration, the abortives should work within 10-15 minutes to be considered adequate therapy.
Oxygen *
- Excellent abortive for cluster
- Shown to work in up to 70% of cluster patients
- Safe and easy to use
- Typical dosing — 100% oxygen given via face mask (nasal cannula not effective) at 7-10 liters/minute for 20 minutes. Pain relief typically occurs after 10-20 minutes
* Can be used daily
Sumatriptan **
- Has been effective in cluster headache. A doctor must be consulted before use
- Injectable form — most effective, often giving complete relief within 15 minutes after injection
- Nasal spray formulation is not as effective as injectable
- Oral tablets are not effective in cluster due to the 1-2 hours it takes for the medication to produce relief; the individual cluster headache is over by then
** Because triptans are not appropriate for daily use and certainly not multiple times each day, this treatment must be reserved for only the most serious attacks
Dihydroergotamine (DHE) ***
- Available in injectable and nasal spray preparations
- Most cluster patients experience relief within 15 minutes when DHE is given intravenously; relief is slower with intramuscular or subcutaneous formulations
*** Can be used for several days in a row but not endlessly
