Studies indicate that for the majority of those with cluster headache, inhaling high-flow oxygen at the onset of pain or during an attack is the single most effective and consistently reliable abortive. The importance of oxygen as a first line rescue medication cannot be underscored enough—Please view our oxygen page to learn everything you need to know about aborting attacks with 100% oxygen.
Level A Recommendations for Acute Abortive Treatment—100% High-Flow Oxygen 12-15 L/min, Sumatriptan Subcutaneous 6mg, Zolmitriptan/Zomig Nasal Spray 5mg—NO Oral Medications
A vasoconstrictor borrowed from treatment for migraine, Sumatriptan Succinate/Imitrex/Sumavel DosePro, is a popular self-injectable abortive. Administered at the onset of pain, relief comes quickly for those who respond to the medication. With continued use over time, however, the drug can cause increased frequency of attacks and elevated pain levels during attacks.
This rebound effect can lead to over-use of the drug, which essentially renders it counter-therapeutic. Many patients ask for sumatriptan vials instead of auto-injectors as some respond to just 2-3mg instead of the full 6mg, which cuts down on rebound attacks and medication-overuse.
Other commonly prescribed abortive medications include:
- Dihydroergotamine/DHE-45 (vasoconstrictor, administered intravenously, by self-injection, or via nasal spray)
- Toradol (injectable anti-inflammatory)
- Octreotide Acetate/Sandostatin LAR (synthetic hormone)
- Zolmatriptan/Zomig (vasoconstrictor nasal spray borrowed from migraine treatment)
- Sphenopalatine ganglion block (SPGB) – View the technique for SPG block
- Lidocaine (intranasally administered local anesthetic) — View Instructions on Lidocaine Use for CH
- Oral Zolmatriptan (vasoconstrictor borrowed from migraine treatment)
- Ergotamine Tartrate/Ergomar (vasoconstrictor borrowed from migraine treatment, taken sub-lingually)
- Ketamine (sedative administered intravenously or via nasal spray)
Capsaicin and Civamide, derived from chili peppers are over-the counter intranasal products used as abortives.
The Vagus Nerve Stimulator by gammaCore is a hand-held device designed and marketed to abort attacks for those with episodic cluster headaches. It is non-invasive and provides electrical stimuli to the vagus nerve in the neck, which can result in pain reduction, elimination, and for some, a decrease in the number of weekly attacks—More information about gammaCore