Subcutaneous injection of
sumatriptan is an effective treatment for attacks of
cluster headache with a short onset of action. This open, randomized study evaluates whether
sumatriptan nasal spray at its highest commercially available dose (20 mg/dose) is equally effective. In 26 patients, four consecutive attacks were treated alternately with
nasal spray and
subcutaneous injection. Treatment was given within 5 min of onset of
pain, and the time interval for the start and completeness of
pain relief, provided these occurred within 15 min of administration, were recorded by the patient. After completion of the study, the patients were also asked to indicate which treatment they preferred, based on efficacy, side effects, and handling of the preparation. Forty-nine of the 52 treatments with injection resulted in complete relief of
pain within 15 min, with a mean of 9.6 min. The remaining three attacks were reduced by a mean of 86.7% at 15 min. Only 7 of the 52 treatments with
nasal spray in the nostril ipsilateral to
pain resulted in complete relief within this time period, with a mean of 13.0 min. In 18 of these treatments
pain was reduced by a mean of 42.2% at 15 min, whereas no effect on
pain was obtained at this time in the remaining 27 treatments. The effect was almost identical when the
nasal spray was administered in the nostril on the non-painful side. As an overall judgement, only 2 of the 26 patients preferred
nasal spray to injection. We conclude that
sumatriptan nasal spray 20 mg/dose is less effective than
subcutaneous injection in relieving
pain in the great majority of
cluster headache sufferers.