Medical Health Encyclopedia

Because effective therapy for cluster headaches is limited, most research efforts focus on the prevention of attacks during cluster cycles. A number of agents are available and may be used alone or in combination. In general, the steps for preventive management are as follows:

Transitional Medications. Patients should use headache medications (typically a triptan, a corticosteroid, or ergotamine) to control any attacks during the transition to on-going maintenance agents.

Maintenance Agents. Prevention of attacks during a cluster cycle is extremely important. Although patients with episodic or chronic cluster headaches may be given different medications, there does not appear to be much difference in their effectiveness for either type. The following are the most commonly used preventive agents:

• Calcium-channel blockers. The calcium-channel blocker verapamil is most often used for preventing cluster headaches.
• Corticosteroids. Tapered doses of corticosteroids may be useful for preventing episodic cluster headaches.
• Lithium. Some studies suggest that lithium is the best agent for chronic cluster headaches.
• Methysergide. This agent is a serotonin inhibitor and is sometimes used for episodic cluster headaches.
• Antiseizure agents. Of the antiseizure agents, valproic acid is most often used. Others that may be useful include carbamazepine, gabapentin, and topiramate.
• Ergotamine. Some experts start with ergotamine, which is useful as a transitional medication.

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Other agents that have been tried include indomethacin, melatonin, beta blockers, tricyclic and other antidepressants, and capsaicin. Combinations may be needed.

Behavioral Treatments

Lifestyle Changes. Patients should avoid the following:

• Alcohol.
• Foods containing nitrates or nitrites (such as smoked meats). No other dietary factors appear to play a role, for good or ill, in this disease.
• Medications containing nitrates (such as nitroglycerin).
• Smokers who can't quit should at least stop at the first sign of an attack and not smoke throughout a cycle.