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How are cluster headaches treated?

Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the headaches that follow need to be prevented.

Initial treatment options may include one or more of the following:

  • inhalation of high concentrations of oxygen (though this will not work if the headache is well established);
  • injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common migraine medications;
  • Spraying or dripping lidocaine, a local anesthetic, into the nostril;
  • dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict; and
  • caffeine.

Prevention of the next cluster headache may include

  • calcium channel blockers, for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS) and diltiazem (Cardizem, Dilacor, Tiazac);
  • prednisone (Deltasone, Liquid Pred);
  • antidepressant medications;
  • lithium (Eskalith, Lithobid); and
  • antiseizure medications including valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax).
Return to Headache

See what others are saying

Comment from: trebors, Male (Patient) Published: June 16

Nobody had worse migraines than mine. My whole brain just 'quit'. Finally after 65 years (72 now) I had my first seizure at 68 and it turned out to be a blessing. The doctor was treating me with a drug that stopped my migraines almost 100 percent. In the last 4 years, I have seen a tiny wavy line in my vision, which has gone in a few minutes. My miracle medicine is lamotrigine.

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Comment from: 45-54 Male (Patient) Published: August 12

My heart goes out to all who, like me, have difficulty managing their headache pain. I have cluster headache - the agony is indescribable and during the last 35 years I have had about a dozen that hurt so much, if I owned a gun, I would surely have taken my life. This year I had aggressive chemotherapy and went into heart failure. The blood vessel dilating action of my heart medications has triggered an onslaught of cluster headaches, my first episode in over 8 years. I have just stopped taking the heart medications and within 48 hours I am improving. Maxalt ODT has been a godsend for the headaches but I am not going to continue taking medications that dilate my blood vessels. I would rather be dead than spend the rest of my days guaranteed of 3 or 4 or more cluster headaches.

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Comment from: lou, 65-74 Female (Patient) Published: August 26

I recently had a fall and a concussion I damaged the nerves in my neck causing severe head pain. I get pain blockers which sometimes help a bit. I tried everything from morphine to anti-inflammatory, no luck.

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