Pain. 1994 Dec;59(3):321-5.

Preventative effect of repeated nasal applications of capsaicin in cluster headache.

Fusco BM, Marabini S, Maggi CA, Fiore G, Geppetti P.

Institute of Internal Medicine VI, University La Sapienza Rome, Italy.

Preliminary studies have shown that repeated nasal applications of capsaicin prevented the occurrence of cluster headache attacks. The present study was designed to verify the difference in efficacy of treatment with nasal capsaicin, depending on the side of application. Fifty-two patients affected by episodic form were divided into 2 groups, one receiving the treatment on the same side where the attacks occurred (ipsilateral side), the other on the controlateral side. Eighteen patients with a chronic form alternately received both ipsilateral and controlateral treatments. Seventy percent of the episodic patients, treated on the ipsilateral side, showed a marked amelioration whereas no improvement was noted in the patients treated on the contralateral side. The efficacy of ipsilateral treatment was emphasized by the results obtained in chronic patients. However, in these patients, the maximum period of amelioration lasted no more than 40 days. The difference between the effects of the 2 treatments (contralateral and ipsilateral) was statistically significant in both episodic and chronic sufferers. The efficacy of repeated nasal applications of capsaicin in cluster headache is congruent with previous reports on the therapeutic effect of capsaicin in other pain syndromes (post-herpetic neuralgia, diabetic neuropathy, trigeminal neuralgia) and supports the use of the drug to produce a selective analgesia.

PMID: 7708405

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Headache. 1994 Mar;34(3):132-7.

"Capsaicin-sensitive" sensory neurons in cluster headache: pathophysiological aspects and therapeutic indication.

Fusco BM, Fiore G, Gallo F, Martelletti P, Giacovazzo M.

Institute of Internal Medicine VI, University La Sapienza, Rome, Italy.

Capsaicin, when repeatedly applied to the nasal mucosa of cluster headache patients, has been shown to prevent the occurrence of pain attacks. In order to investigate the mechanism of the drug's action, we evaluated the effect of repeated nasal application of capsaicin on the contents of sensory fibres immunoreactive to substance P and CGRP in the rat nasal mucosa. Further, considering the possible involvement of the cerebral circulation, we verified the effect of a single application of capsaicin on the blood flow velocity of the internal carotid and middle cerebral arteries (of both sides) and the basilar artery, in a group of healthy humans. The measurements were taken using Doppler devices. In order to verify the reproducibility of therapeutic effect of capsaicin, we carried out a 2-year follow-up study on patients affected by cluster headache (17 by episodic form, 8 by chronic form) who responded positively to the first treatment with capsaicin. During this period they were treated again with capsaicin in case of re-occurrence of symptoms. Capsaicin depletes the fibers immunoreactive to substance P and CGRP in the rat nasal mucosa. In the healthy controls, a single application induced vasodilation in the internal carotid, whereas middle cerebral arteries and basilar artery were narrowed. The results of the follow-up study, demonstrates that in 65% of the patients, the beneficial effect of capsaicin was again present when the treatment was repeated. In the chronic patients the therapeutic effect was always transitory (lasting, at maximum one month).(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 7515383

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Cephalalgia. 1993 Apr;13(2):114-6.

A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache.

Marks DR, Rapoport A, Padla D, Weeks R, Rosum R, Sheftell F, Arrowsmith F

Clinical Immunology Unit, Massachusetts General Hospital, Boston 92114.

It has been suggested that treatment of cluster headache (CH) patients with topical capsaicin may desensitize sensory neurons by depleting the nerve terminals of substance P. We attempted to determine whether capsaicin is effective in aborting CH attacks. Patients in acute cluster were randomized to receive either capsaicin or placebo in the ipsilateral nostril for 7 days. Patients recorded the severity of each headache for 15 days. Headaches on days 8-15 of the study were significantly less severe in the capsaicin group vs the placebo group. There was also a significant decrease in headache severity in the capsaicin group on days 8-15 compared to days 1-7, but not in the placebo group. Episodic CH patients appeared to benefit more than chronic CH patients. These results indicate that intranasal capsaicin may provide a new therapeutic option for the treatment of this disease.

PMID: 8495452

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Clin J Pain. 1989;5(1):49-53.

Beneficial effect of capsaicin application to the nasal mucosa in cluster headache.

Sicuteri F, Fusco BM, Marabini S, Campagnolo V, Maggi CA, Geppetti P, Fanciullacci M.

Institute of Internal Medicine and Clinical Pharmacology, University of Florence, Italy.

Capsaicin application to human nasal mucosa was found to induce painful sensation, sneezing, and nasal secretion. All of these factors exhibit desensitization upon repeated applications. The acute effects induced by capsaicin (300 micrograms/100 microliters) application to the nasal mucosa were studied in healthy volunteers and cluster headache patients. These effects were not different in both nostrils of cluster headache patients as well as in the single nostril of healthy controls. Likewise, the time course of desensitization to the painful sensation and nasal secretion induced by capsaicin applied for five consecutive days in control subjects was almost superimposable to those observed in the nasal mucosa of cluster headache patients. The number of spontaneously occurring attacks was significantly reduced in the 60 days after the end of capsaicin treatment. Whether the beneficial effect induced by capsaicin application to the nasal mucosa could be ascribed to a specific action on sensory neurons remains unknown.

PMID: 2520386

I'm a new member of this forum.  I've been having daily (2-3 times per day) cluster headaches for over 35 years.  I've been treated by every kind of practitioner I can think of and nothing has worked until this past month when I went to see a D.O. at Dartmouth Medical Center.  She suggested several treatments, most of which I've tried.  Then she said I might try using Capsaicin.  She suggested forming a paste from it and inserting a small dab onto the mucus membrane in my nostril (my headaches are always on the left side). 
To make a long story short, I got some CHILLI PEPPER from my wife's kitchen, mixed a very small amount with water to form a paste and then put it on my fingertip and thence up into my nostril.  Did it burn?  Yes, a bit.  (smelled great).  Did it work?  YOU BET.
I have since acquired some nasal spray which also works, and I swear that my headache is now 99.9 percent GONE.  I no longer have to use the spray or the paste on a daily basis, and, while I can still feel a small throb behind my eye, it is Nothing compared to what was.  I'm 71 years old and am now looking forward to daily life.
Tony