Dr. Robbins Says….

The main abortives for clusters remain:

1.  triptans (Imitrex, Maxalt, etc.),
2.  oxygen
3.  analgesics
4.  lidocaine nasal spray
5.  ergots.

Triptans do work the best, particularly Imitrex injections (many cluster sufferers get by with 2 or 3mg, which is half of a vial).  Oxygen, 100% at 7 to 10l/min, works for about 60% of pts.  Analgesics can take the edge off, but do not stop the headache.  Lidocaine is very mildly, if at all, effective, but may be helpful while awaiting something else to work.  Ergots are not used much anymore, but can be very helpful, albeit with more side effects.

The cost of Botox, unfortunately, just went up.. from about $390 per 100unit vial to approx $417 a vial.

The cost of Botox does limit it’s use;  the average patient now recieves 50 to 100 units per treatment.  In the earlier days, we used lower doses.  I do think Botox has a role to play in migraine, CDH, and clusters, but the role is still being worked out.