Headaches: Cluster - Treatment

Managing Cluster Headaches

Management of cluster headaches focuses on:

• Acute therapy for stopping an attack while it is happening
• Preventive therapy for stopping or reducing attack recurrences

Treating Attacks

The most effective and best-studied treatments for a cluster attack are:

• Oxygen inhalation.
• Triptan drugs. Usually an injection of the triptan drug sumatriptan (Imitrex), which is FDA-approved for cluster headache treatment. Intranasal formulations of sumatriptan or zolmitriptan (Zomig) are alternatives.

Relief can occur in 5 - 10 minutes. Oxygen and sumatriptan injection are sometimes given together.

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Other drugs that may be used for acute attacks are nasal sprays of dihydroergotamine or lidocaine.

Preventing Attacks

Cluster headache attacks are usually short, lasting from 15 - 180 minutes, and the excruciating pain may have subsided by the time a patient reaches a doctor’s office or emergency room.

Because it can be difficult to treat attacks when they occur, treatment efforts focus on the prevention of attacks during cluster cycles. Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.

Verapamil (Calan), a calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches. However, it can take 2 - 3 weeks for this drug to take effect. During this period, corticosteroids (typically prednisone) may be used as an initial transitional therapy. For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.

Although they are not FDA-approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin) are sometimes used for preventive treatment.

Behavioral Treatments and Lifestyle Changes

Behavioral Treatments. Behavioral therapies can be a helpful accompaniment to drug treatment. These approaches can help with pain management and enable patients to feel more in control of their condition.

Behavioral approaches include: