Cluster Headaches - Treatment

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What is the treatment for cluster headaches?

The treatment of cluster headache can be divided into two distinct categories -- relief of the acute headache and prevention of future headaches. Oxygen delivered by face mask has been shown to help up to 70% of patients within a short period of time. However, this can be unwieldy, and most patients are unable or unwilling to transport oxygen canisters if they need to travel. Injectable sumatriptan has been shown to be beneficial in more than 75% of patients with cluster headache. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable. Dihydroergotamine, given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours. Intranasal lidocaine has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly.

Steroids can be extremely effective to decrease a headache cycle; these can be used infrequently and are for short-term use only as long-term use can lead to significant complications. Verapamil, lithium, valproic acid, topiramate, and melatonin can all be of benefit in reducing the frequency and severity of cluster cycles. In intractable cases, surgery has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency, but is associated with significant side effects and nerve loss; gamma knife lesioning and deep brain stimulation are being studied as possible options with less risk of permanent nerve change.

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Comment from: Connie, 55-64 Male (Patient) Published: November 11

I suffered with cluster headaches throughout most of my military career. Doctors tried quite the array of different types of medication, of which none of them worked. When I was subscribed injectable Imitrex, I was amazed at how fast it worked. I could feel the headache start diminishing in about 5 to 15 seconds. The problem is that the pharmacy did not want to give me more than three vials per prescription. Not much help when you are having 3 or 4 episodes a day for a month and a half to two months. Shortly after I retired, I went in for a prescription of Lexapro for depression. I have not had a cluster attack since 2002. That makes it 13 years since I have had a cluster headache attack. Although I wouldn't mind getting off of Lexapro because I no longer feel depressed, I will probably always be on it to keep cluster headaches away.

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Comment from: m. wallace, 25-34 Female (Patient) Published: February 10

I have had constant, daily pain in the top right quarter of my head for over a year. The cluster headache has progressively gotten worse to the point I can barely see out of my right eye and even when pain goes my eye does not return to normal. I have had 2 MRIs done with the last showing a cyst in one of the ventricles. Doctor does not feel this has anything to do with my symptoms. I went for a third MRI this week so will see how that goes. Working is horrible and daily pain is taking a toll on me. I'm depressed and frustrated. I am taking verapamil and Zomig however they don't work very well. Close to my time of the month the pain gets lighter. I feel popping, stabbing, a washing type feeling over that part of my head. My ears hurt, my teeth bug me and it occasionally feels like the rush you hear when you yawn, pulling everything to the corner of eye. The few people I have encountered that have had clusters say they lasted up to 6 months and then go away. I am just past a year with no relief in sight.

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