Triptans for cluster headaches

Examples

Generic Name	Brand Name
sumatriptan succinate	Imitrex
zolmitriptan	Zomig

The injected form of sumatriptan is used to treat cluster headaches. Self-injection kits are available so that you can give yourself the shot. Nasal and oral sumatriptan are also available.

You can take zolmitriptan as a pill (by mouth) or use it as a nasal spray.

How It Works

Triptans (sometimes referred to as 5-HT-1 receptor agonists) shrink the blood vessels in the brain, which may relieve pain by reducing pressure from inflammation that can occur with cluster headaches. Triptans may also affect certain brain chemicals that regulate pain.

Why It Is Used

Sumatriptan may be injected, sprayed in the nose (nasal spray), or taken by mouth as a pill to stop cluster headaches.

Zolmitriptan may be sprayed in the nose (nasal spray) or taken by mouth as a pill to stop cluster headaches.

How Well It Works

If it is injected soon after a cluster headache starts, sumatriptan can relieve headache pain within 15 minutes.¹ Up to 90% of people have reduced headache pain when given a sumatriptan injection as soon as a cluster headache first begins.²

Nasal and oral sumatriptan are less effective than the injectable form.

Zolmitriptan, when used as a nasal spray early in a cluster headache, can relieve headache pain within 20 minutes. A higher dose may relieve headache pain even faster.³

The pill form of zolmitriptan (taken by mouth) does not relieve cluster headache pain as well as injected sumatriptan.⁴

Side Effects

Injected sumatriptan may cause the following side effects:

• Flushing
• Tingling
• Dizziness
• A feeling of warmth or coldness
• Burning at the injection site

The nasal spray of either medicine may cause:

• Nausea.
• Bad taste in the mouth.

Side effects usually develop shortly after receiving the medicine and go away within 1 hour. Some people may feel chest pressure or tightness. This is usually not dangerous.

The U.S. Food and Drug Administration (FDA) has issued a warning about taking SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors), two kinds of antidepressant medicines, with triptans. Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Triptans should not be used if you have heart disease, uncontrolled high blood pressure, or are pregnant or nursing.

Triptans should not be combined with certain other medicines, such as ergotamines.

Triptans can be very expensive, so the cost of treating frequent cluster headaches can add up. If you are thinking about using triptans to treat your cluster headaches, you may want to weigh the cost of a triptan against the cost of other medicines, office visits, and time lost from work.

It is important that you do not use triptans on a daily basis to treat or prevent cluster headaches. Overuse of triptans can cause you to have more headaches when the medicine wears off. These are called rebound headaches. If you feel like you need to use triptans often, talk to your doctor. He or she may have you try a different medicine.

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Author:	Monica Rhodes	Last Updated: April 11, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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