Markley HG. (2003). Topical agents in the treatment of cluster headache. Curr Pain Headache Rep. Apr;7(2):139-43
Abstract
Cluster headache produces one of the most intense pains known to man. Despite this, its exact pathophysiology remains unknown. Because of its elusive cause, no existing therapy can be designed specifically to relieve the symptoms. However, empirically various abortive and prophylactic medications have been found to be effective, although many patients still fail to respond to treatment. The standard approach to management is to prescribe a daily prophylactic medication, with the expectation that the frequency and duration of the attacks will diminish. One or several acute abortive medications is added to this preventive management to stop individual “breakthrough” attacks. The abortive treatment must have a rapid onset of action because the cluster attack usually is over within 45 minutes to 1 hour and because the pain is so excruciating. Many patients fail to respond to a “cookbook” approach to therapy; many therapeutic options are needed. Many different abortive and prophylactic delivery routes have been investigated, including subcutaneous injection, oral tablets, sublingual preparations, nasal spray and drops, rectal suppositories and inhaled aerosols. This review discusses topical intranasal medications.
