Intranasal medications for the treatment of migraine and cluster headache

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, lidocaine (lignocaine) and calcitonin have been used for relief of migraine and cluster headache, but have not yet been widely accepted.