How are cluster headaches treated?
Abortive medications: The most successful treatments are sumatriptan (Imitrex®) injections and oxygen inhalation therapy (100% oxygen delivered by a face mask at eight to 10 liters per minute for twenty minutes). Other choices include: zolmitriptan nasal spray, dihydroergotamine injections and, in rare cases, peripheral and central nervous system stimulation.
Preventive medications: Medications should be prescribed as early as possible in order to shorten the length of the headache period as well as decrease the severity of the headaches. All cluster headache sufferers must take preventive medication unless their cluster periods last less than two weeks. Some medications used in the prevention of cluster headaches include: calcium channel blockers, verapamil, lithium carbonate, divalproex sodium, melatonin, and topiramate.
Surgical intervention may be considered for people with chronic cluster headaches who have not been helped with standard therapy. There is research going on now with both deep brain and occipital nerve stimulation.
Because of the brief duration of an attack, the abortive treatment of these headaches is difficult. Often, the acute headache has disappeared before the patient arrives at the emergency department or physician’s office to receive treatment. Oxygen inhalation by facial mask can be used at the first signs of a cluster attack and has been used successfully in aborting an acute cluster headache. Sumatriptan injections or nasal spray or other acute treatment (see above) is often prescribed for the acute treatment of cluster headaches.
All of these treatments should be used under the direction of a physician familiar with cluster headache therapy. As with any medication, it is important to carefully follow the label instructions and your physician’s advice. This is especially important to prevent rebound headaches.