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: Charlie L., 55-64 Male (Patient) Published: March 07

My visit from the cluster headaches (CH) usually begins an hour into sleep. The pain is so excruciating that I feel if a gun were in the house, I"d be tempted. I have a loving wife who feels so helpless but does her best to help with whatever she can. I was in remission for the last 4 months. Oxygen has been my savior, 10 to 12 liters a minute cuts the CH down from 45 minutes to 10 to 15 minutes. Ice on the back of my neck also helps but O2 is the best for me. I want to say to anyone that has these, hang in there. Try anything your doctor puts in front of you, sooner or later you can find some relief.

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Comment from: chadnjen9182, 19-24 Male (Patient) Published: March 14

I also suffer from the cluster headache behind the left eye. I do not know what causes it, I used to think it was stress but now it seems random. The only method that has ever worked is hot shower in the dark and I mean hot. Humming to keep the mind off the pain and then cold shower. It sounds like I'm off my rocker but if you're like me, you know. I would beat myself over the head with a rock if I thought it would help. Hang in there fellow cluster freaks.

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