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Nasal Spray Shows Promise Against Cluster Headaches

It's typically used to treat migraine pain, researchers say

WEDNESDAY, Sept. 13, 2006 (HealthDay News) -- New research suggests that a nasal spray used to treat migraine headaches also relieves the pain of extraordinarily debilitating "cluster" headaches.

With few side effects, the nasal spray -- zolmitriptan (Zomig) -- appears to work by targeting nerves that carry pain signals. "It's very convenient and very safe," said study co-author Dr. Peter Goadsby, professor of clinical neurology at University College London. "It's good news for patients."

Cluster headaches are much less common than migraines, affecting about one in 1,000 people. They typically strike in clusters once or twice a year, causing attacks one or two times a day for two to three months, Goadsby said.

Cluster headaches, whose causes are unclear, appear to be connected to cycles of light and dark. According to Goadsby, the clusters are most common around the spring and fall equinoxes, and the headaches themselves often happen at specific times during the day, such as 1 p.m., 10 p.m. and 4 a.m.

"You can almost set a clock by what happens," Goadsby said.

The attacks themselves are "quite unique," lasting for about two hours but on just one side of the head, he said.

Unfortunately for patients, the headaches are extremely difficult to tolerate. "A cluster is like a hot poker in the eye," said Dr. Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University Hospital in Philadelphia and spokesman for the American Headache Society.

There are treatments for cluster headaches, including pure oxygen and a variety of drugs, but they don't work for all patients. Enter the nasal spray known as zolmitriptan, which is used to treat migraines.

In the new study, researchers tested the spray on 92 patients, 80 of whom were men, the gender most likely to get cluster headaches. Because some patients dropped out of the study or did not have enough headaches during the study period, 69 patients were included in the final analysis.

The researchers randomly assigned the participants to be treated with a placebo, 5 milligrams of the nasal spray, or 10 milligrams when their headaches occurred. They were then checked several times over a half-hour period. If the headaches didn't get better after that time, the patients were allowed to try another treatment.

The research was funded by AstraZeneca, manufacturer of the nasal spray. The findings appear in the November issue of Archives of Neurology.

After a half hour, patients who took the 10-milligram dose reported feeling better 61 percent of the time, compared to 42 percent and 23 percent of those who took the smaller dose and the placebo, respectively.

Those who took the 10-miligram dose were pain-free at a half hour about 50 percent of the time, compared to 28 percent and 16 percent of those who took the smaller dose and the placebo, respectively.

According to the study, one patient dropped out after suffering from shortness of breath, vomiting and joint pain.

Goadsby said the nasal spray is easy to use, and publicity about the research should both raise the profile of cluster headaches -- which often aren't diagnosed -- and help improve treatment.

Silberstein, who has received funding from AstraZeneca and is familiar with the study findings, agreed that the nasal spray is now a good treatment for cluster headaches. "It's a way of handling the attack until it gets under control with preventive medication," he said.

According to Silberstein, the drug appears to work by targeting nerves that carry pain and turning them off.

More information

Learn more about cluster headaches from the American Academy of Family Physicians.

SOURCES: Peter J. Goadsby, M.D., Ph.D., professor of clinical neurology, Institute of Neurology, University College London, England; Stephen Silberstein, M.D., director, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia; November 2006, Archives of Neurology
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