Cluster Headache Treatment

Treatment aims to reduce the frequency of headaches and help relieve the pain.

Lifestyle Changes and Self-care

• Maintain the same sleep routine. Avoid afternoon naps or sleeping in, which may bring on more headaches.
• Do not drink alcoholic beverages. Even a small amount of alcohol can trigger a headache during a cluster period.
• Learn stress management techniques. Stress can bring on a headache.
• Do not smoke. Tobacco may interfere with medication to relieve the headache.

Medication

Drugs used to treat migraines often relieve acute attack of cluster headaches. These drugs must be taken at the first sign of a headache.

Drugs used to treat cluster headaches include:

• Sumatriptan or other triptans
• Dihydroergotamine (eg, Migranal)
• Lidocaine-nose drops or spray on the affected side
• Pain relievers with caffeine
• Prednisone (eg, PredniSONE Intensol)
• Ergotamine (eg, Ergomar)
• Octreotide (given as an injection)
• Glycerol (given as an injection into the nerve)-used when the other treatments are ineffective

In some cases, the headache does not last long enough for drugs to be beneficial. Sometimes, the drugs just delay an attack, rather than stopping an attack.

Pain killers, especially narcotic drugs, should not be used during an acute attack.

Other medicines (usually used in combination) are given on a regular basis to prevent or reduce the frequency of headaches. These drugs include:

• Verapamil (eg, Calan, Isoptin)-to relax and dilate the blood vessels
• Lithium (eg, Eskalith)-blood levels of this drug must be monitored
• Methysergide (eg, Sansert)-most helpful in younger people in early stages of disease
• Prednisone-taken for a short period while other drugs are started
• Dihydroergotamine or a triptan (medications to treat migraines)-for people who suffer from cluster headaches at predictable times, such as at night
• Topiramate (eg, Topamax)
• Baclofen (eg, Lioresal)
• Valproate (eg, Depakote) or gabapentin (eg, Neurontin)
• Beta-blockers
• Clonidine (eg, Catapres-TTS)
• Melatonin
• Amitriptyline (eg, Apo-Amitriptyline)
• Topical capsaicin cream
• Selective serotonin reuptake inhibitors (SSRIs)

Oxygen Therapy

Breathing 100% oxygen for 10-15 minutes often relieves cluster headache pain. The oxygen appears to decrease blood flow to the affected area of the brain. People under age 50 who have episodic cluster headaches seem to benefit most from oxygen therapy.

Oxygen therapy can be expensive, though, and there are risks with this therapy.

Surgery

As a last resort, some doctors may recommend cutting or destroying a facial nerve to eliminate the pain.