My starting point on such questions is to search the medical literature to gain experience from large scale, controlled experiences of others.

PDF file, below, supplies a broad range of meds with ratings of effectiveness.

=====
My favor abortive has not been broadly studied but several of us, here, have had excellent results consistent with the outcomes in this abstract. Apart from effectiveness, it's cheap (on a per dose cost basiss), has the advantage of being a pill (when you talk about traveling). The only caution is if you needed it more than 1-2x/day. But for my 1x day attacks, it was consistently effective in 15-20 minutes.
======
Headache 2001 Sep;41(8):813-6 

Olanzapine as an Abortive Agent for Cluster Headache.


Rozen TD.
Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and TWO PATIENTS BECAME HEADACHE-FREE AFTER TAKING THE DRUG. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.

PMID 11576207 PubMed

--------------------------------------------------------------------------------


Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

There was a recall on the injections in the fall.  It may have affected the nasal spray.  Can you get the injections?

Maryo,

We had a similar problem with Cafergot here in Australia in 2009, when the machine used to manufacture it broke down and the decision was taken by the manufacturer not to re-tool, or replace the very old machine used to manufacture Cafergot.

So many Cafergot users have used compounding Pharmacies here in Oz to have Ergotamine injections, tablets or capsules made for them. I don't know if this service is available in the US, but I assume, with research, that there would be some raw Ergotamine type compound that could be found and made into useable delivery methods and dosages by a compounding Pharmacy.

I hope this helps, maybe not in the US, but it's all I got for ideas from here.

Re: Zyprexa.

I don't know why this information keeps getting posted.
I ran this past my specialist, A Professor of Clinical Phramacology and Headache specialist. He knows drugs and CH, has more than 80 "first in human" molecular structures to his name and has conducted over 800 clinical trials, many in Headache research. His first contribution to Headache as a Pharmacologist was Zolmitriptan (Zomig).

In CH circles, few have his understanding of drugs, how they are thought to work, how they don't work and what is of most efficacy in his many CH patients.
I ran this Olanzapine in CH study by my specialist.

Firstly, despite seeing no plausible way Olanzapine may work in CH, he of course had an open mind. Because nobody knows how CH works, how drugs work, or how drugs MAY work in CH, if at all.

If I wanted to trial Olanzapine, I was welcome to. Regulatory approvals could be obtained through Drug Approvals boards and ethics committees for its appropriate use in my chronic, intractable case. So, thanks for the idea Bob, it was considered and I have tried the drug.

Neither I nor my Specialist were put off by the drug's primary usage. After 70 drug trials in CH myself, I am no longer concerned about a chemical compound's intended usage, I am always however, thoroughly assessed for appropriate use and monitored closely for safety.

My experience with Olanzapine (Zyprexa):
Upon using Zyprexa, of concern to me was the side effect profile - a bad one. Including, but not limited to potential for MASSIVE weight gain. The term "Massive" specifically and medically used by my specialist.
I ballooned around 7kg in a week, it was unbelievable.
Diabetes could become an issue very quickly.
Withdrawal from the drug was terrifying, in my case.
I shook for a week. it took me over a year to lose the weight I gained using Zyprexa. Topiramate is like methamphetamine in the "dopey" department, compared to Zyprexa. Zyprexa turned me into a sleeping, eating, drooling zombie with one of the worst side-effect profiles I have experienced in over 25 years of 70+ drug trials and 35 years chronic CH. Withdrawal from the drug, for me was absolutely terrifying. But that was just me - one patient.

My own meager Zyprexa experiences aside...If long term "off label", or "open label" Olanzapine use for CH were to be continued in the long term, ongoing risk vs benefit assessment would have to be carried out in each individual patient. I'm not alone in that sentiment.

Quote:


I understand, this is CH we're talking about.
Sometimes the risks of not medicating under the duress of chronic and severe pain outweigh the risks of some medications. Like Verapamil, individualising Zyprexa usage in CH cases would perhaps be appropriate and a decision for a very specialised few to make, one would think.

I also think anyone using this study to support prescription of Zyprexa in CH and approaching their specialist about it should be made aware of the Olanzapine data sheet, for safety and a list of known contraindications and side-effect profile(s).

Let's "assume" that CHers are to use an ~10mg dose, as per the posted study and that patients have Zyprexa indicated for use as an abortive in CH. They will be seeking the fastest mode of delivery - in this case, the sub-lingual wafer, or Orally Disintegrating Tablet (ODT) forms:

Here is the (Australian) Consumer medical Information (CMI) on Zyprexa wafers and tablets: 

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Here is the (Australian) Product Information (PI) on Zyprexa:

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

If both patients and practitioners access these documents before prescribing Olanazapine for use in CH, a more informed risk assessment can be conducted.
An educated patient makes "better" informed decisions.

The study is of only 5 participants, not exactly compelling, long-term evidence for its use in CH. The study shows that Olanzapine was specifically selected for use in those patients with "contraindications to vasoconstrictive drugs", not as a replacement for vasoconstrictive drugs, like Cafergot. Perhaps suggesting, that other well known abortives be tried before resorting to Olanzapine as a first port of call...

Unlike us laymen out here, my specialist was able to access the entire study criteria and parameters.
Allegedly, the selection criteria were pretty slack and there are no controls. The study does not exclude the concomitant use of other preventives, abortives, or factor in spontaneous remission of CH.The trial conclusion is no better than anecdotal, at best.

The study itself received a Journal Impact Factor of just 2.94. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Quote:


Since 2001, when the 5 patient study was conducted, there has been no follow up. The article is from very credible researchers, but somehow they have not seen fit to repeat or further validate their claim to efficacy in CH.

They conclude that Olanzapine "appears to be a good abortive agent for cluster headache". If so, then why no follow up, or further study since 2001?

We (CHers) need more follow up on long term Zyprexa use in any condition for which it is prescribed. I think a clear distinction need be made that the study intended the drug to be used as an alternative, in patients who cannot use vasoconstrictors, before the drug name is thrown out there to anyone seeking relief from CH.

I'm all for options Bob and Zyprexa is clearly one of them, I tried it, under close supervision. But after 3 or 4 near death experiences with my own clinical trials, I'm also for informed patients and appropriate risk vs benefit assessment, underpinned by access to the documents, side-effects and safety record of the drug in question.

Cheers, Ben.