Couple of suggestions

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Posted by Bob Johnson ( on January 27, 2001 at 15:01:56:

In Reply to: Need some serious help ASAP posted by KarenT on January 27, 2001 at 13:48:29:

May need to talk to the doctor about using Imitrex injection while waiting for the other medications to take effect. Especially the Verap--it may take several days to weeks before it becomes effective. May also wish to print out the following and talk to the doc about dosing; looks like he is being too conservative.

This from:, operated by Dr. Robbins who has a headache clinic outside of Chicago.

Table 16: First Line Abortive Medications for Cluster Headache

Oxygen: Very effective, with no side effects. May be combined with other abortives. Oxygen is worth trying for all patients willing to rent a tank; the usual dose is 8 liters/min., for 10 to 20 minutes as needed, with a mask, used sitting up and leaning slightly forward. 60% success rate.

Sumatriptan (Imitrex) injection: The most effective cluster headache abortive medication. The injections often work within minutes, and cluster patients prefer this route of administration. However, patients may at times require two or three injections in a day. Chest heaviness or pressure, tingling or hot sensation, nausea, fatigue, etc. may occur.

Sumatriptan (Imitrex) nasal spray: The 20 mg. nasal spray is convenient and easy to use. While not as effective or as fact acting as the injection, many patients do prefer this route. Side effects tend to be minimal, but a bad taste in the mouth is common. Cluster patients often require two, or at times, even three nasal sprays in a day. Many patients utilize nasal spray at times, and the injections at other times. Occasionally, the tablets of triptans are preferred by cluster patients.

Table 17: Quick Reference Guide: First Line Cluster Preventive Medication

Cortisone: Very effective for cluster headache; is used primarily for episodic clusters. It is given for 1 or 2 weeks during the peak of the cluster series. Prednisone, Decadron, or injectable forms may be utilized. When used for short periods of time, side effects are minimal. A typical regimen is prednisone (20 mg.) or Decadron (4 mg.) once a day for 3 days, then one-half pill per day for 10 days, then stop. Additional cortisone may be given later in the cycle, when the clusters increase. Higher doses may be needed.

Verapamil (Covera HS, Calan, Isoptin, Verelan): A well tolerated calcium channel blocker; effective in episodic and chronic cluster. One 240 mg. SR pill is taken once or twice per day. This is often initiated at the onset of the headaches, in conjunction with cortisone. Verapamil is then continued after the cortisone is stopped. Constipation is common. Because of its efficacy and a lack of side effects, verapamil is a mainstay of cluster prevention.

Lithium: Very helpful for chronic cluster and, to a lesser degree, episodic cluster. Small doses, one to three of the 300 mg. tablets per day, are used for cluster headache. May be combined with verapamil and/or cortisone. Lithium is usually well tolerated in low doses; drowsiness, mood swings, nausea, tremor, and diarrhea may occur. Blood tests need to be done.


Also look in the archives (button to left)and print out a long message posted on 11/26/00, "cluster resources--#9". Start with the book and medical articles sections.

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