What are the treatment options for cluster headaches?
While there is no cure for cluster headaches, treatment focuses on stopping/reducing headache pain, shortening the cluster periods, and preventing future attacks. An individual treatment plan should include a temporary form of initial relief with steroids, a daily preventive medication, and a way to provide immediate treatment relief for an ongoing attack.
Pain relief needs to be fast-acting because cluster headaches start and stop abruptly. For that reason, oral medications (such as opioids for pain relief), which are relatively slow to act, are too slow to provide acute treatment for cluster headaches.
Treatments may include:
High-dose pure oxygen through a face mask for 15 to 20 minutes can stop or lessen an attack in progress, often within 15 minutes. Oxygen has no side effects, but patients need to have ready access to an oxygen cylinder and regulator. Small, portable oxygen units are available but may be impractical for many patients.
Sumatriptan (Imitrex) nasal spray can constrict blood vessels in the brain, which relieves pain. The injectable form of sumatriptan (also used to treat migraine) is more effective and works quicker for most people. People with heart disease or uncontrolled high blood pressure should not take sumatriptan.
Zolmitriptan (Zomig) has an effect similar to sumatriptan and is available in nasal spray for fast-acting treatment.
Octreotide (Sandostatin), an injectable synthetic version of the brain hormone somatostatin, helps some patients. It’s slower-acting and less effective than sumatriptan.
Local anesthetics, such as lidocaine, can help numb the pain with a nerve block. It’s given for temporary relief by injection through the nose; may be used with corticosteroids and/or verapamil.
Dihydroergotamine as an injection, helps relieve pain for some patients.
Daily medications can help prevent future headaches. You may be prescribed:
-Verapamil is a calcium channel blocker that relaxes blood vessels. Side effects can include constipation, nausea, fatigue, swelling of the ankles, and low blood pressure.
-Prednisone is a corticosteroid that reduces inflammation and swelling for a few days. Not advised for long-term use because it can cause diabetes, high blood pressure, and cataracts.
-Lithium carbonate restores balance to brain chemicals, and may be used if other medications aren’t preventing headaches. Side effects include tremor, increased thirst and diarrhea. Patients on lithium must have regular blood tests to check for kidney damage.
Vagus nerve stimulation, which delivers electrical stimulation to the vagus nerve through the skin, has been found to reduce the frequency of cluster headaches.
Anti-seizure medications (Topamax, Qudexy XR) are sometimes used to prevent cluster headaches.
Surgery may be done on patients who cannot take medications or who have chronic cluster headaches that don’t respond to aggressive treatments.
Sphenopalatine ganglion stimulation involves surgery to implant a neurostimulator that's operated by a hand-held controller. Initial research showed quick pain relief and a lower frequency of headaches.
-Occipital nerve stimulation involves surgery to implant an electrode next to one or both occipital nerves.