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.

Several new triptans (Imitrex-type meds) have come on the market in the past year and a half;  Axert (almotriptan) came out 1.5 years ago, and more recently Frova.  There are pluses and minuses to each.

Axert is relatively mild, with very few chest symptoms;  it is well tolerated, but does not always pack the impact (work as well) as Imitrex.  Frova is longer-lasting, with a half-life of 26 hours, which can be both good and bad.  I will explain more about Frova later.  Frova is mild, takes longer (up to 2 hours) to work, and is good for longer-developing,  slower onset, more moderate migraines.