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.

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