Treatment
Sumatriptan injection for cluster headache in New Zealand
Sumatriptan 6mg subcutaneous injection is one of the two first-line acute treatments for cluster headache. It works for most patients within about 10–15 minutes and is funded by PHARMAC in New Zealand.
If you are in the middle of an attack, go to the attack page for immediate steps including exactly how to use sumatriptan. Come back here once the attack has passed.
What sumatriptan is and how it works
Sumatriptan is a triptan - a class of drug that acts on serotonin receptors. It narrows blood vessels around the coverings of the brain and settles down the trigeminal nerve pathway involved in an attack.
For cluster headache, only the subcutaneous (injection) form is effective. Sumatriptan tablets are too slow - the drug takes too long to be absorbed to keep pace with the rapid onset and relatively short duration of a cluster headache attack. The injection delivers the drug directly under the skin and typically works within about 10–15 minutes.
PHARMAC funding in New Zealand
Sumatriptan 6mg injection is funded in New Zealand.
It is funded as a standard prescription item, and the funding is not restricted to any particular condition. Your pharmacist can tell you which brand is funded at the moment, as this changes from time to time.
Funding is accessed via a standard prescription from your GP or neurologist. There is no special authority or prior approval required for cluster headache. Your GP simply writes a prescription for sumatriptan 6mg injection and it will be dispensed at any pharmacy.
PHARMAC funding decisions can change. Always confirm current funding status with your GP or pharmacist. The PHARMAC Community Schedule is the authoritative source.
How to use the injection
- At the first sign of an attack, take out the injection pen.
- Follow the instruction leaflet that comes in the box, and ask your pharmacist or practice nurse for a demonstration if you have not used one before.
- Pain relief typically begins within about 10–15 minutes and the attack should be substantially reduced.
- If your first injection does not work, do not give a second injection for the same attack - use oxygen instead. A second injection may only be used for a later, separate attack, at least 1 hour after the first, and no more than 2 injections (12 mg) in 24 hours.
Contraindications and who should not use sumatriptan
Do not use sumatriptan if you have:
- Ischaemic heart disease (angina, heart attack) or coronary artery disease
- History of stroke or TIA (transient ischaemic attack)
- Uncontrolled high blood pressure
- Peripheral vascular disease
- Severe liver impairment
- Recent use of ergotamine or ergot-type migraine medicines - doses must be separated by at least 24 hours
- MAO-inhibitor antidepressants (and use caution with SSRIs/SNRIs, due to serotonin-syndrome risk)
- Hemiplegic or basilar migraine (this applies to migraine, not cluster headache, but is noted for completeness)
This list is not exhaustive. Always discuss your full medical history with your GP before using sumatriptan. If you are unsure whether sumatriptan is safe for you, use oxygen as your primary acute treatment while you seek medical advice.
Sumatriptan limits and cluster periods
During an active cluster period, many patients experience multiple attacks per day. Sumatriptan is limited to 2 injections per 24-hour period, which means it cannot cover every attack in high-frequency periods. This is where oxygen becomes particularly important - oxygen has no daily use limit and can be used for every attack.
Some neurologists recommend using oxygen as the primary treatment for every attack and reserving sumatriptan for attacks where oxygen is not available (when away from home, for example), or for attacks that oxygen does not fully abort.
Getting sumatriptan prescribed
Ask your GP for a prescription for sumatriptan 6mg subcutaneous injection for cluster headache. If your GP is unfamiliar with this use, share the GP fact sheet PDF from this website. The prescription is straightforward once your diagnosis is confirmed.
If you are having difficulty getting the right treatment, ask for a referral to a neurologist. A neurologist can prescribe sumatriptan, write a management letter to your GP and ensure you have a complete acute treatment plan in place.
The best approach for most cluster headache patients is to have both oxygen and sumatriptan available. Oxygen for every attack at home, sumatriptan for attacks when oxygen is not available. Read about getting oxygen prescribed in New Zealand and verapamil as the main preventive treatment to reduce the number of attacks you need to treat.