Lettucehead wrote on Jun 12^th, 2010 at 9:36am:

     You gotta be shittin.  You have a new life on the way,  but would take worthless narcotics for a headache.  I'm appalled.
You got o2 use it.

                Potter

Headache. 2009 Jan;49(1):136-9.
Cluster headache during pregnancy: case report and literature review.

Giraud P, Chauvet S.

Centre hospitalier d'Annecy, Service de Neurologie, Metz-Tessy, France.

A 32-year-old pregnant woman presented with cluster headache (CH) during the third trimester of a normal pregnancy. Pure oxygen mask inhalation was ineffective, and intranasal lidocaine applications were realized associated with oral methylprednisolone, given at 1 mg per kg once daily. These treatments rendered the pain tolerable and the pregnancy went to its term with no consequence on the baby. This case of CH attack during pregnancy raises the issues of the influence of sexual hormonal changes in women with CH and the way to treat this disease in such circumstance. To date, there are no therapeutic guidelines available; this case suggests some possibilities.

PMID: 19125883 [PubMed
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Ann Pharmacother. 2008 Apr;42(4):543-9. Epub 2008 Mar 18.
Use of 5-HT1 agonists in pregnancy.

Evans EW, Lorber KC.

Department of Clinical and Administrative Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA. eevans@ulm.edu

OBJECTIVE: To report and evaluate available data on the use of serotonin 5-HT(1) agonists (triptans) during pregnancy. DATA SOURCES: A PubMed search, limited to English-language articles on human subjects, was conducted (1990-December 2007) using the search terms pregnancy, migraine, and the individual triptan drug names. In addition, the manufacturers of all 7 available triptans were contacted regarding the existence of a pregnancy registry for their drug(s) and the availability of registry reports. STUDY SELECTION AND DATA EXTRACTION: All retrospective and prospective studies reporting on pregnancy outcomes after the use of a triptan were included and critically evaluated. Data from all available manufacturer-sponsored pregnancy registries were also included. DATA SYNTHESIS: Safe and effective treatment of migraine during pregnancy is imperative. DATA INVOLVING SUMATRIPTAN AND, TO A LESSER EXTENT, NARATRIPTAN AND RIZATRIPTAN, EXIST PRIMARILY REGARDING EXPOSURE IN THE FIRST TRIMESTER. THESE DATA SHOW NO SIGNIFICANT DIFFERENCES IN CONGENITAL MALFORMATIONS OR POOR PREGNANCY OUTCOMES WHEN COMPARED WITH EXPECTED RATES IN THE GENERAL POPULATION OR WITH THE OBSERVED RATES IN CONTROL SUBJECTS. THERE IS VERY LITTLE INFORMATION REGARDING EXPOSURE IN MIDDLE AND LATE PREGNANCY. CONCLUSIONS: SUMATRIPTAN APPEARS TO BE A SAFE TREATMENT ALTERNATIVE FOR PREGNANT WOMEN WHO EXPERIENCE NEW-ONSET OR WORSENED MIGRAINES IN THE FIRST TRIMESTER. FURTHER OBSERVATION IS NEEDED PRIOR TO RECOMMENDING ITS USE IN LATER TRIMESTERS. BASED UPON AVAILABLE DATA, THE OTHER AGENTS IN THIS CLASS CANNOT BE RECOMMENDED FOR USE DURING PREGNANCY AT THIS TIME.

PMID: 18349309 [PubMed]
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Ther Drug Monit. 2008 Feb;30(1):5-9.
Triptans in pregnancy.

Soldin OP, Dahlin J, O'Mara DM.

Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA. os35@georgetown.edu

The triptans are a class of tryptamine-based drugs indicated for in the treatment of migraine headaches. The triptans act as serotonin (5-hydroxytriptamine) (5-HT) agonists by binding to various serotonin receptors, causing vasoconstriction and neuronal inhibition to alleviate migraines. There are 7 types of triptans currently available on the U.S. market: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan. The objective of this study was to examine the use and effects of triptans in pregnancy. ALTHOUGH THREE OF THE TRIPTANS HAVE PREGNANCY REGISTRIES MAINTAINED BY THE MANUFACTURER, TRIPTAN USE IN PREGNANCY HAS NOT BEEN EXTENSIVELY STUDIED. INFORMATION ON THE USE OF SUMATRIPTAN DURING PREGNANCY IS RELATIVELY MORE ABUNDANT, BECAUSE IT HAS BEEN ON THE MARKET LONGER THAN THE OTHER TRIPTANS AND MAY ALSO HAVE A HIGHER PERCENTAGE OF THE MARKET SHARE. THERE ARE NO DATA TO SUGGEST TERATOGENICITY FOR ANY OF THE TRIPTANS, ALTHOUGH PRETERM BIRTH RATES APPEAR TO BE ELEVATED.

Publication Types:
Review

PMID: 18223456
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Cephalalgia. 2009 Jan 19. 
Treatment of cluster headache in pregnancy and lactation.

Jüergens TP, Schaefer C, May A.

Department of Neurology, University of Regensburg, Regensburg, Germany.

Jüergens TP, Schaefer C & May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia 2009. London. ISSN 0333-1024Cluster headache is a rare disorder in women, but has a serious impact on the affected woman's life, especially on family planning. Women with cluster headache who are pregnant need special support, including the expertise of an experienced headache centre, an experienced gynaecologist and possibly a teratology information centre. The patient should be seen through all stages of the pregnancy. A detailed briefing about the risks and safety of various treatment options is mandatory. In general, both the number of medications and the dosage should be kept as low as possible. PREFERRED TREATMENTS INCLUDE OXYGEN, SUBCUTANEOUS OR INTRANASAL SUMATRIPTAN FOR ACUTE PAIN AND VERAPAMIL AND PREDNISONE/PREDNISOLONE AS PREVENTATIVES. IF THERE IS A COMPELLING REASON TO TREAT THE PATIENT WITH ANOTHER PREVENTATIVE, GABAPENTIN IS THE DRUG OF CHOICE. WHILE BREASTFEEDING, OXYGEN, SUMATRIPTAN AND LIDOCAINE FOR ACUTE PAIN AND PREDNISONE/PREDNISOLONE, VERAPAMIL, AND LITHIUM AS PREVENTATIVES ARE THE DRUGS OF CHOICE. As the individual pharmacokinetics differ substantially, adverse drug effects should be considered if unexplained symptoms occur in the newborn.

PMID: 19170693
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Re: Clusters and Pregnancy
« Reply #1 on: Oct 29th, 2004, 8:37am »   

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Issues about med effects are sufficiently complex and  fluid that I would work closely with your ob doc and, ideally, with a headache specialist (acting as a consultant).

Given where you are in your pregnancy, you might print out this message and show to your doc.
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CNS Drugs. 2003;17(1):1-7.   


Safety of sumatriptan in pregnancy: a review of the data so far.

Loder E.

Harvard Medical School, Boston, Massachusetts, USA. eloder@partners.org

The high prevalence of migraine in women during their reproductive years means that new drug treatments for migraine, such as the serotonin 5-HT(1B/1D) receptor agonists (the 'triptans'), are likely to be widely used by women of childbearing potential. Scrutiny of these agents in an effort to detect any signal of teratogenicity is thus important. A systematic review of the medical literature was conducted to identify information regarding the safety of sumatriptan during pregnancy. This agent was chosen to be investigated because it has been available for the longest and is the most widely used of the triptan class. Information was obtained regarding the impact of migraine on pregnancy outcome, and data on sumatriptan use in pregnancy were obtained from animal studies, preclinical drug trials, postmarketing surveillance efforts, prospective pregnancy registries, national birth registries and teratogen information services. Synthesis of information from these sources is sufficient to rule out a large increase in birth defects from sumatriptan use during pregnancy and is reassuring for cases where inadvertent exposure to sumatriptan during pregnancy has occurred. However, current information is not sufficient to rule out small increases in the risk for birth defects. For this reason, caution should be exercised in making a positive recommendation for the use of sumatriptan during pregnancy.

Publication Types: 
Review 
Review, Tutorial 

PMID: 12467489 [PubMed] 
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I checked drug info on medscape.com and this is o.k. for limited use in pregnancy. 

1: Headache 2001 Sep;41(:813-6   


Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.



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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
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OTC meds are not very helpful with cluster, as you know, but may be one of the few options available to you. Some folks have good luck aborting/easing an attack by applying an ice pack to the pain site. Others find very hot water also works; others have used a hair dryer blasting the pain site works! No predicting; just try.

Bob Johnston - you rock!  Excellent excellent work!  Wonderful help and thank you thank you for taking the time and care to help me!  I'm planning on printing out the info and taking it into my OB and Neuro.  Thank you again!

Potter - you're an unhelpful ass.  Well done for making the already anxious and overwhelmed pregnant lady tear up... 

As for my narcotics - I'm thinking I didn't make myself clear - I generally take 1-2 fioricet and 1 5/325 oxycodone per day.  1 fioricet and 1/2 tab of oxycodone at the start of the CH with a heat pack and 15lpm o2 with nonbreather (that's the highest my regulator will go) and sometimes intranasal lidocaine - these usually beat the pain back enough to get through the next hour or 2 of the CH.  Yes, I could take more narcotics but I'm willing to take the level of pain in order to protect my baby.  My CH last long enough that the meds do help and have time to kick in.  1-2 fioricet and 1/2 to 1 oxycodone per day do not an addiction make and despite my OB saying it was OK, I'm refuse to take more...
Last Thurs, I actually went about 24hrs (oh glorious!) without a CH and didn't take any meds and didn't have any problems...

I am totally planning on trying the energy drink angle tonight though! 

Bob Johnston, again, thank you.  Even if none of the options work out, you tried to help and I thank you...

I've been told that I can't take tripans or DHE with the baby because of concerns about uterine blood flow.  No verapamil because of concerns about fetal heart block and bradycardia.  No neurontin because of fetal issues with bones and kidneys.  No lithium because of fetal heart defects and multiple other issues.

Look people, I'm regretful that several have a problem with the small amount of narcotics I take, but I'm in a bit of a rock and a hard place.  I'm freaking out here and I don't know what to do. 
I've been told to get an abortion because of the concern of adequately treating my CH and still keeping the baby healthy.  I want my baby.  I want to stop hurting.  Please, I want to sleep a whole night through.  I don't want to be fired for missing work so much.  I want my baby to be healthy.  I want my baby!!!!  Please, please I want my baby to be ok and I want to not hurt so much...  please....

Lettucehead,

There all kinda folks who respond here, and just keep in mind that many of us are going to be sympathetic to your situation.

Then there are the other folks....

Those who say they are appalled by you, question whether you are real, or take it upon themselves to dispatch reprimands to you and issue you stern orders - They'll never have to walk in your shoes with the combination of multiple daily CH attacks lasting hours each while being pregnant and struggling to hang onto a job.

Yet somehow they decide they are going to come down hard on you. I don't get that, but hey it's one crazy planet.

And just so you know, Potter responds to people, especially women, like that all the time, and he is called an ass, called out for being unhelpful, etc. by them on a very regular basis. People DO actually call people names around here, and most often Potter is on the receiving end of them on account of his, um, style.. you are not at all alone!

Hey Potter if you're concerned about that baby you need to open your eyes and see that your approach clearly only alienates most of the new people who post here that dare not to be already on your program, and who are promptly handed the fist of the caveman, or whatever you call your style.

Just because you think it's right doesn't make it work. Quite the opposite, seen here time and time again.

The baby thanks you - not - for that.

Going after pregnant women in a way that is pretty much guaranteed to make them reject your "advice"....you must feel so righteous.

Thank you, Bejeeber...
I think I needed to hear from someone that at least the difficulty of my situation is recognized.  Perhaps I won't completely give up on this 'support' site.  Perhaps.  Hmmm...

I haven't felt so attacked and demoralized in quite a while. 
So far, from my understanding, I've been called a junkie, fake, bad mother, selfish and self-centered, drug-seeking? (I'm not sure what Jimi was getting at - my OB GAVE me these meds in an attempt to help the pain but have the least possible developmental effect on the baby)...

I reached out to post because I was already feeling so overwhelmed and helpless/hopeless.  I'm in frequent contact with my own OB and I'll never take something that I haven't cleared with her first.  I've contacted so many docs from neurologists to OBs to FMs and they didn't have anything else to offer until about 16-20 weeks of baby development.  That's another 2-6 weeks and I know I just need to hold on - I'm just so tired of hurting and no sleep...

I was just hoping someone not necessarily medical but who had actually BEEN there had something to offer...

Again, Bob Johnson, thank you.  I'll be calling my primary OB on Mon and see if we discuss some of these options starting now and not a month from now.
Again, thank you Bejeeber.  A kind word means alot right now...

Hey Lettucehead, don't worry about Potter he is just our forum troll although a fellow sufferer.

Do stay on our boards and research aswell as seek help for your malady.

I would suggest Oxygen for starters with high-flow of 30lpm.

Brew wrote on Jun 12^th, 2010 at 11:22pm:

Sorry but no, I am with bejeeber on that, Lettuce perhaps is hooked up, but we are still CH family to support eachother not troll eachother. Even though I agree with potter on the Oxygen part of info and fact drugs are bad and not helping with CH, although it could be explained in more polite way, than making person feel uncomfortable and getting picture of us being some elitist jerks.