Medications may stop a cluster headache after it starts and prevent additional headaches from occurring. Finding the right medication can take some time. You may need a combination of medications 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 (Cafergot, Wigraine), which narrow blood vessels to relieve pressure and reduce headache pain.
• High-flow oxygen inhalation therapy, which is inhaled through a face mask to quickly relieve headache pain.
• Intranasal lidocaine, which is taken by nose drops to stop severe headache pain.
• Sumatriptan (Imitrex), which is injected to narrow blood vessels and reduce pressure and pain. This medication can also be taken as a nasal spray, although it may be less effective than the injection.⁷

Medicines that prevent cluster headaches are called prophylactic headache medications. You must take these medicines every day, even on days when you do not have headaches. They include:

• Calcium channel blockers, such as verapamil hydrochloride (Calan, Isoptin, Verelan), which relax narrowed blood vessels and reduce pain. Verapamil hydrochloride is commonly used for preventing both occasional and chronic cluster headaches.³
• Corticosteroids, such as prednisone, which can break a headache cycle, although it is not clear how these medications work.
• Lithium. Lithium carbonate (Lithobid, Lithonate, Lithotabs, Eskalith) 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 medications such as divalproex sodium (Depakote), valproate (valproic acid), or topiramate (Topamax), which may be tried if other treatments are not effective.

What To Think About

Over-the-counter pain medicines, such as aspirin, 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 hydrocodone bitartrate and acetaminophen (Vicodin), propoxyphene napsylate and acetaminophen (Darvocet), oxycodone hydrochloride (OxyContin), oxycodone hydrochloride and acetaminophen (Percocet), and morphine.

When a cluster headache occurs, it is important to use the medication your doctor has recommended as early as possible. The sooner you treat the headache, the less painful it may be.

The choice of medication may depend on the time of day when your headaches tend to occur. Some people may need a combination of 2 or 3 medications. Keeping track of your symptoms can help your health professional determine the proper medication. You can keep track by using a headache diary(What is a PDF document?).