Spraying capsaicin (aka Civamide, aka the hot stuff in hot peppers) sounds painful in itself.  THis is a preventative they're talking about.

CH-free, still, since the first of August! A couple of minor migraines, but it has been an awesome two months with almost no pain!

1.  Headache response at 15 or 30 minutes, defined as a reduction in headache from moderate, severe, or very severe to mild or no pain (symptomatic trials)
2.  Pain-free response at 15 or 30 minutes (symptomatic trials)
3.  Cessation of CH attacks within a specific time period (preventive trials)
4.  Number of days on which a CH attack occurred (preventive trials)

Spraying capsaicin (aka Civamide, aka the hot stuff in hot peppers) sounds painful in itself.

27 of them were prospective, double blind, randomised RCTs

In 60 years.

Pretty damn pathetic.

Bob

Summary of advisements for preventive treatment of cluster headache

Civamide
Direct evidence that civamide 100 µL is
effective in improving headache response
in CH. Nonserious adverse events: nasal
burning, lacrimation, pharyngitis,
rhinorrhea.
One randomized, controlled
clinical trial; AAN Class I
Level B: should be considered
for the prevention of CH

Suboccipital steroid injection
Direct evidence that long- and rapid-acting
steroids 2.5 mL are effective in improving
headache response in CH. Nonserious
adverse event: transient injection site pain.
One randomized, controlled
clinical trial; AAN Class I
Level B: should be considered
for the prevention of CH

Sodium valproate
Direct evidence that sodium valproate 500
mg is not effective in improving headache
response in CH. Adverse events not
reported.
One randomized, controlled
clinical trial; AAN Class I
Level B: not advised for the
prevention of CH

Sumatriptan
Direct evidence that sumatriptan 100 mg
is not effective in improving headache
response in CH. Nonserious adverse
events: nausea, vomiting, headache,
malaise.
One randomized, controlled
clinical trial; AAN Class I
Level B: not advised for the
prevention of CH

Melatonin
Evidence that melatonin 10 mg is effective
in improving headache response in CH.
Nonserious adverse events: none reported.
One randomized, controlled
clinical trial; AAN Class II
Level C: may be considered
for the prevention of CH

Verapamil
Evidence that verapamil 360 mg is
effective in improving headache response
in CH. Nonserious adverse events:
constipation, reduced blood pressure,
reduced heart rate.
Two randomized, controlled
clinical trials; 1 AAN Class II, 1 AAN Class III
Level C: may be considered
for the prevention of CH

Cimetidine/chlorpheniramine
Evidence that cimetidine 2,000 mg and
chlorpheniramine 20 mg are not effective
in improving headache response in CH.
Nonserious adverse events: transient,
erythematous skin rash. Other adverse
events not reported.
Two randomized, controlled
clinical trials; 2 AAN Class II
Level C: not advised for the
prevention of CH

Lithium
Evidence that lithium 900 mg is effective
in improving headache response in CH.
Nonserious adverse event: polyuria.
Two randomized, controlled
clinical trials; 2 AAN Class II
Level C: may be considered
for the prevention of CH

Misoprostol
Evidence that misoprostol 300  g is not
effective in improving headache response
in CH. Adverse events not reported.
One randomized, controlled
clinical trial; AAN Class II
Level C: not advised for the
prevention of CH

Oxygen
Evidence that 100% hyperbaric oxygen is
not effective in improving headache
response in CH. Adverse events not
reported.
One randomized, controlled
clinical trial; AAN Class II
Level C: not advised for the
prevention of CH

Capsaicin
Insufficient evidence that capsaicin is
effective in improving headache response
in CH. Adverse events not reported.
One randomized, controlled
clinical trial; AAN Class III
Level U: insufficient evidence
to advise for the prevention
of CH

Nitrate tolerance
Insufficient evidence that nitrate tolerance
via 5-ISMN 30 mg is effective in improving
headache response in CH. Adverse events
not reported.
One randomized, controlled
clinical trial; AAN Class III
Level U: insufficient evidence
to advise for the prevention
of CH

Prednisone
Insufficient evidence that prednisone 20
mg every other day is effective in
improving headache response in CH.
Adverse events not reported.
One randomized, controlled
clinical trial; AAN Class III
Level U: insufficient evidence
to advise for the prevention
of CH

Source: Francis GJ, Becker WJ, Pringsheim TM (August 2010). "Acute and preventive pharmacologic treatment of cluster headache". Neurology 75 (5): 463–73. Table 4.
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