Preventative effect of repeated nasal applications of capsaicin in cluster headache

Abstract

Preliminary studies have shown that repeated nasal applications of capsaicin prevented the occurrence of cluster headache attacks. The present study was designed to verify the difference in efficacy of treatment with nasal capsaicin, depending on the side of application. Fifty-two patients affected by episodic form were divided into 2 groups, one receiving the treatment on the same side where the attacks occurred (ipsilateral side), the other on the controlateral side. Eighteen patients with a chronic form alternately received both ipsilateral and controlateral treatments. Seventy percent of the episodic patients, treated on the ipsilateral side, showed a marked amelioration whereas no improvement was noted in the patients treated on the contralateral side. The efficacy of ipsilateral treatment was emphasized by the results obtained in chronic patients. However, in these patients, the maximum period of amelioration lasted no more than 40 days. The difference between the effects of the 2 treatments (contralateral and ipsilateral) was statistically significant in both episodic and chronic sufferers. The efficacy of repeated nasal applications of capsaicin in cluster headache is congruent with previous reports on the therapeutic effect of capsaicin in other pain syndromes (post-herpetic neuralgia, diabetic neuropathy, trigeminal neuralgia) and supports the use of the drug to produce a selective analgesia.

Topical agents in the treatment of cluster headache

“…Fusco et al [25] reported another study showing that the efficacy of intranasal capsaicin depended on the delivery to the ipsilateral side of the pain. Fifty-two patients with episodic cluster headache received capsaicin on the ipsilateral or contralateral side to the pain.…”

Cluster headache

“…On days 8 to 15, however, after the application had been stopped, the capsaicin-treated group demonstrated significantly less severe headache (P<0.001), both when compared to headache scores for days 1 to 7 within the group and when compared to headache scores for both time periods (days 1 to 7 and days 8 to 15) in the group receiving placebo. Fusco et al [38,Class II] have demonstrated that capsaicin applied to the nostril ipsilateral to the pain was associated with marked amelioration of pain in 70% of 70 patients (51 with episodic headache and 19 with chronic cluster headache). No improvement was noted in patients treated in the nostril contralateral to the pain.…”

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

“…Un essai, déjà ancien, a été conduit sur 51 patients et a permis d'obtenir une réduction de 50 % du nombre des crises [95]. Les effets indésirables étaient essentiellement la sensation de brûlure.…”