Cluster headaches cause the worst pain imaginable, leading some patients to thoughts of suicide. They occur in about 0.1% of the population, while migraine headaches afflict 12%, which may explain why so much less research has been conducted on cluster than on migraine headaches. Injectable sumatriptan (Imitrex) is the only drug approved by the FDA for cluster headaches. We do use many other medications “off-label” for both acute and prophylactic treatment, but none have been subjected to rigorous research. That is none, until recently – zolmitriptan nasal spray (Zomig NS) has been shown to be effective in relieving cluster headaches within 30 minutes. While the dose of Zomig NS for migraines is 5 mg, in this latest trial both 5 and 10 mg dose was studied. The 10 mg dose was better than 5 mg dose in patients with episodic cluster headaches (74% vs 52%), but these two doses were equally effective in patients with chronic cluster headaches (41% vs 42%). The advantage of Zomig NS over Imitrex injection is that it is easier to use and does not involve a painful injection, while the advantage of Imitrex is that it works faster. Zomig NS is now approved for acute treatment of cluster headaches in Germany, Netherlands and Denmark.
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