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One traditional treatment for acute cluster attack is oxygen. Unfortunately, many patients do not respond to this therapy. Trying oxygen therapy is somewhat difficult. In general, insurance companies do not want to provide oxygen until they know it will work. Since the headache is quite short and commonly at night, it is difficult for patients to get to oxygen fast enough to try it. I usually ask patients to check with their dentist to see if oxygen is available at their office as most patients live closer to their dentist than they do to my office. I will also give them a note to hand to the ER triage nurse giving them an oxygen order in case they are able to get to an ER in time. If oxygen is effective, it is very useful.

For those patients for whom oxygen does not work, then Imitrex® injections are usually the treatment of choice. The fast onset of these injections in general make it a better choice than the tablets. If the headaches are somewhat longer or the patients are needle-phobic, then Zomig® or Imitrex® nasal spray is commonly tried. If this is not successful, then any of the fast acting triptan tablets (Axert®, Imitrex®, Maxalt®, Zomig®) can be tried. What also may be a problem for many patients is getting their insurance to pay for their acute triptan use. Injections are commonly used at a very high rate during cluster attacks.

Less commonly used is DHE (dihydroergotamine) injections. These injections are harder to give than Imitrex® and are associated with more side effects. This is particularly true when relatively more frequent doses (compared to migraines) are given. Both the triptans and DHE are contraindicated in patients with ischemic heart disease.

Prevention of Cluster Headache