Highlights
Cluster headaches are extremely painful and very difficult to treat. A headache diary may be helpful to identify and avoid triggers. When a headache occurs, record the date and the time, list any activities, substances used or consumed within the previous 24 hours, and any other factors that seem significant. Common triggers include:
- Foods that contain nitrates or nitrates (such as smoked meats).
- Cigarette smoke.
- Alcohol.
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Medications
Various medications are used to treat and prevent cluster headache attacks. These drugs include triptans, corticosteroids, ergotamine, calcium channel blockers, lithium, and anti-seizure medications. Oxygen therapy is also helpful for treating attacks.
Surgery
Surgery may be a last resort for patients with severe daily cluster headaches that do not respond to any other treatment. However, these surgical procedures are still experimental. Recent research findings include:
- Deep Brain Stimulation. Of all surgical procedures for cluster headaches, deep brain stimulation has been the most researched and shows the most promise. A small generator, similar to a heart pacemaker, is implanted under the collarbone. The surgeon runs an electrode from the generator to the hypothalamus section of the brain. The generator sends electrical pulses that stimulate the hypothalamus. According to a 2005 review, 16 patients have been treated with good results.
- Vagus Nerve Stimulation. This procedure is similar to deep brain stimulation, but the generator is implanted in the chest and the wire is connected to the vagus nerve in the neck. In a 2005 clinical trial of six patients, vagus nerve stimulation helped improve cluster or migraine headache in five patients. One patient had severe nausea.
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