Cluster Headaches
Medications
Medicines may stop a cluster headache after it starts and prevent additional headaches from occurring. Finding the right medicine can take some time. You may need a combination of medicines to effectively treat your cluster headaches.
Medication Choices
Treatments used to stop cluster headaches are called abortive headache treatments and most often include:
- Ergotamine preparations, such as ergotamine tartrate with caffeine (such as Cafergot), which narrow blood vessels to relieve pressure and reduce headache pain.
- High-flow oxygen inhalation therapy, in which you breathe oxygen through a face mask to reduce blood flow to the brain and relieve headache pain. Around 7 out of 10 people treated with oxygen soon after the start of a headache get relief within 10 to 20 minutes.2 But you need to repeat the treatment when the next headache begins.
- Intranasal lidocaine, which is taken by nose drops to stop severe headache pain.
- Triptans (Imitrex, Zomig), which can be injected to reduce pressure and pain. These medicines can also be taken by mouth as a pill or sprayed in the nose.
Medicines that prevent cluster headaches during a cluster period are called prophylactic headache medicines. You must take these medicines every day during a cycle of headaches, even on days when you do not get a headache. They include:
- Calcium channel blockers, such as verapamil hydrochloride (Isoptin, Verelan). These medicines are used to prevent cluster headaches or reduce the number of headaches in a cluster period. Verapamil hydrochloride is commonly used for preventing both occasional and chronic cluster headaches.
- Lithium. Lithium carbonate (Carbolith, Lithane) is thought to affect the brain's biological clock (hypothalamus), which some experts think is linked to cluster headaches, although the specific problem or abnormality that triggers cluster headaches is unclear. Lithium is often prescribed to prevent chronic cluster headaches.
- Antiseizure medicines, such as divalproex sodium (Epival), valproic acid (Depakene), or topiramate (Topamax). These may be tried if other treatments are not effective.
- Methysergide, methysergide maleate (Sansert).
Corticosteroids, such as prednisone. These medicines are used to stop cluster headaches for a short time. These medicines give you some relief from headaches while preventive medicines start to work. This type of medicine is called a transitional medicine. Corticosteroids are not used as preventive medicines long term because of bad side effects.
What To Think About
Over-the-counter pain medicines, such as ASA, acetaminophen, and ibuprofen, usually do not relieve the severe pain of cluster headaches. Also, prescription narcotic pain medicines are not recommended for cluster headaches. Such prescription medicines that are not recommended include oxycodone hydrochloride (OxyContin), oxycodone hydrochloride and acetaminophen (Percocet), and morphine.
When a cluster headache occurs, it is important to use as early as possible the medicine your doctor has recommended. The sooner you treat the headache, the less painful it may be.
The choice of medicine may depend on the time of day when your headaches tend to occur. Some people may need a combination of 2 or 3 medicines. Keeping track of your symptoms can help your doctor determine the proper medicine. You can keep track by using a headache diary
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The U.S. Food and Drug Administration (FDA) has issued a warning on antiseizure medicines and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take antiseizure medicine should be watched closely for warning signs of suicide. People who take antiseizure medicine and who are worried about this side effect should talk to a doctor.
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| Author: | Douglas Dana Monica Rhodes | Last Updated: May 28, 2008 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology | |
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