Treatment
of Cluster Attacks
Since cluster headaches strike so quickly and with little or no warning, the
best treatments are those that work most rapidly. Inhaled oxygen and injected
Imitrex (Sumatriptan) are currently among the most effective treatments.
Other treatments include:
- DHE (Dihydroergotamine) is available for home use in injectable form or as Migranal Nasal Spray. It may also be administered intravenously in a hospital or physician's office.
- Lidocaine has been useful for some cluster headache users. It is administered either in nasal spray or drops forms. According to Dr. Lawrence Robbins in his book Headache Help, it is useful for less than one-third of patients.
- In a study conducted by Bahra A, Gawel MJ, Hardebo JE, Millson D, Breen SA, Goadsby PJ.; Zomig (Zolmitriptan) was more effective than placebo for episodic cluster headache but not chronic cluster headache.2
Prevention of Cluster
Attacks
Obviously, preventing cluster attacks is the most desirable goal. There are two
different approaches to cluster prevention:
- Transitional prevention refers to
medications given when a cluster period begins and discontinued when it
ends.
- Corticosteroids such as prednisone and desamethasone) are often used to help the patient through the period it takes other preventives to take effect.
- Ergotamine Tartrate and DHE may be used daily for a short period of time up to two or three weeks, also to allow other preventives to begin acting. Used in this way, they do not seem to present a risk of rebound headache.
- Maintenance or long-term prevention refers
to using preventive meds indefinitely to prevent he onset of cluster
periods. These medications are often begun during a cluster period, then
continued beyond its end. Some of the medications used for this purpose are:
- Depakote (Valproic Acid)
- Verapamil
- Lithium Carbonate
- Melatonin
- Topamax (Topiramate)
- Indomethacin
- Amerge (Naratriptan) In a recent case study, authors Pje Eekers and Pj Koehler stated, "We believe naratriptan may be a promising new prophylactic drug for refractive cluster headache. Provided that safety issues of daily usage are resolved, it may replace other prophylactic drugs in cases of too many side-effects. We recommend a double-blind placebo-controlled study to confirm the efficacy and safety of naratriptan as a preventive drug in cluster headache."3
Are
YOU a ClusterHead?
If you think you have cluster headaches, you
should consult your physician. It is important that a proper
diagnosis be made, and other conditions be ruled out. If a diagnosis
of cluster headaches is made, your physician will work with you to
find a treatment regimen to help deal with the headaches and work to
prevent them. A headache diary is a
very helpful tool in the diagnosis and treatment of headaches.
~ Teri Robert
1 Silberstein, Stephen D., Lipton, Richard B., Dalessio, Donald J.; Wolff's Headache and Other Head Pain, Seventh Edition, 2001. Chapter 12, Dodick, David W., Campbell, J. Keith "Cluster Headache: Diagnosis, Management and Treatment," 283-321.
2 Headache: The Journal of Head and Face Pain 41 (3), 330-342.
Available from: http://dx.doi.org/10.1046/j.1526-4610.2001.111006330.x
3 Eekers, Pje & Koehler, Pj; "Naratriptan prophylactic treatment in cluster headache." Cephalalgia 21 (1), 75-76.
