Fluticasone as Treatment for Cluster Headaches in a Navy Aircrew Member

Cluster headaches (CHs) are one of the most debilitating of all the identified headache syndromes. Their pathogenesis is poorly understood, which has made their treatment challenging. Various medicines and modalities have been put forth in an effort to minimize the symptoms, but none have proven to be consistently reliable. For the active duty military aviator with CHs, this is further compounded by the administrative restrictions to use many of those medications secondary to their unwanted and potentially dangerous side effects. We present a case of refractory CH in an active duty air crewman, treated with fluticasone, which resulted in a remarkable reduction in symptoms allowing him to resume his primary flight duties. We propose that fluticasone's effectiveness in improving his CH symptoms stems from its anti-inflammatory properties.