Summary
Intranasally administered medications for the treatment of headache have recently received increased attention because they offer a rapid onset of activity, even in patients with nausea and vomiting. In addition, patients are likely to use intranasal agents earlier in the course of a headache attack because the intranasal route overcomes potential patient objections to administration of agents by injection and suppository.
Although not yet widely available, intranasally administered headache medications are likely to enjoy widespread acceptance once introduced to markets worldwide. At present, butorphanol nasal spray is available for use in severe headache and other pain syndromes only in the US. This drug is a synthetic opioid agonist-antagonist and thus is useful for pain control when an opioid is required. Dihydroergotamine nasal spray has recently become available in Canada, and should be available in the US and other countries in the near future. Sumatriptan nasal spray has recently been approved in The Netherlands and should soon be available throughout Europe. Other abortive migraine agents may become available in tablet or capsule form and later for nasal administration. Capsaicin, lido-caine (lignocaine) and calcitonin have been used for relief of migraine and cluster headache, but have not yet been widely accepted.
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References
The Sumatriptan Cluster Headache Study Group. Treatment of acute cluster headache with sumatriptan. N Engl J Med 1991; 325: 322–6
Spierings ELH, Saxena PR. Antimigraine drugs and cranial arteriovenous shunting in the cat. Neurology 1980; 80: 696–701
Berde MB, Schild HD, editors. Ergot alkaloids and related compounds. New York: Springer-Verlag, 1978: 4-5, 15–7
Horton BT, Peters GA, Blumenthal LS. A new product in the treatment of migraine: a preliminary report. Proc Staff Meet Mayo Clin 1945; 20: 241–8
Sturmer E. Effects of ergotamine and dihydroergotamine on the resistance and capacitance vessels of skin and skeletal muscle in the cat. Postgrad Med J 1976; 52 Suppl. 1: 32–9
Meilander S, Nordenfeit J. Comparative effects of dihydroergotamine and noradrenaline on resistance, exchange and capacitance functions in the peripheral circulation. Clin Sci 1970; 39: 183–201
The Dihydroergotamine Nasal Spray Multicenter Investigators. Efficacy, safety, and tolerability of dihydroergotamine nasal spray as monotherapy in the treatment of acute migraine. Headache 1995; 35: 177–84
Physicians’ desk reference. Montvale: Medical Economics Company, 1996
Winner P, Ricalde O, Le Force B, et al. A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine. Arch Neurol 1996; 53: 180–4
Humbert H, Cablac M, Dubray C, et al. Human pharmacokinetics of dihydroergotamine administered by nasal spray. Clin Pharmacol Ther 1996; 60: 265–75
Ziegler D, Ford R, Kriegler J, et al. Dihydroergotamine nasal spray for the acute treatment of migraine. Neurology 1994; 44: 447–53
Dahlöf C. Sumatriptan nasal spray: a review of data from multinational clinical trials. Funct Neurol 1996; 11; 150
Finnish Sumatriptan Group and the Cardiovascular Clinical Research Group. A placebo-controlled study of intranasal sumatriptan for the acute treatment of migraine. Eur Neurol 1991; 31: 332–8
Salonen R, Ashford E, Dahlöf C, et al. Intranasal sumatriptan for the acute treatment of migraine. J Neurol 1994; 241: 463–9
Hoffert MJ, Couch JR, Diamond S, et al. Transnasal butorphanol in the treatment of acute migraine. Headache 1995; 35: 65–9
Homan RV. Transnasal butorphanol. Am Fam Physician 1994; 49: 188–92
Fusco BM, Marabini S, Maggi CA, et al. Preventative effect of repeated nasal applications of capsaicin in cluster headache. Pain 1994; 59; 321–5
Marks DR, Rapoport A, Padla D, et al. A double-blind placebocontrolled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993; 13: 114–6
Kittrelle JP, Grouse DS, Seybold ME. Cluster headache: local anesthetic abortive agents. Arch Neurol 1985; 42: 495–8
Robbins L. Intranasal lidocaine for cluster headache. Headache 1995; 35: 83–4
Kudrow L, Kudrow DB, Sandweiss JH. Rapid and sustained relief of migraine attacks with intranasal lidocaine: preliminary findings. Headache 1995; 35: 79–82
Maizels M, Scott B, Cohen W, et al. Intranasal lidocaine for treatment of migraine. A randomised, double-blind, controlled trial. JAMA 1996; 276(4): 319–21
Micieli G, Cavallini A, Martignoni E, et al. Effectiveness of salmon calcitonin nasal spray preparation in migraine treatment. Headache 1988; 28: 196–200
Hart LL, Hobdy-Henderson KC. Calcitonin in migraine. DICP 1991; 25: 1185–6
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Rapoport, A.M., Sheftell, F.D. Intranasal Medications for the Treatment of Migraine and Cluster Headache. CNS Drugs 7, 37–46 (1997). https://doi.org/10.2165/00023210-199707010-00005
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DOI: https://doi.org/10.2165/00023210-199707010-00005