You want relief -- now. Although there isn't a cure, there are treatments that can cut down on how long these headaches last and how painful they are. Some even work to prevent a cluster.
Your doctor will help you figure out what you need. You may have to take more than one medicine.
When a Cluster Headache Has Started
Take action at the first sign of head pain. Oxygen and prescription drugs that doctors call triptans are the two most common treatments for clusters that have already started.
If your doctor prescribes oxygen, you'll breathe through a mask connected to an oxygen tank for 15-20 minutes. It's a safe, effective way to ease this type of pain.
Triptans can often shorten your headache and give you pain relief. These drugs include:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Alsuma, Imitrex, Onzetra Xsail, Sumavel DosePro, Zembrace SymTouch)
- Zolmitriptan (Zomig)
Most triptans are pills. Some come as nasal sprays. You get others as shots. (Your doctor can show you how to do this at home.)
You shouldn't take triptans if you have certain heart or blood vessel problems. If you can't use these treatments, or if they don't work for you, your doctor may suggest:
Octreotide . This drug is a lab-made form of somatostatin, a growth hormone. You take it through an IV in your vein.
Lidocaine . This is an anesthetic, or a "numbing" drug. You spray it up your nose on the painful side of your head.
Ergot alkaloids. These meds are tablets that dissolve under your tongue. You need to take them at the first sign of a cluster in order for them to work. There's another form of this drug called DHE that you usually take through an IV.
These treatments aim to stop cluster headaches from happening. You take them at the start of a cluster episode.
When and how much you take depend on how long yours usually last and how often you get them. Work with your doctor to find the best schedule for you.
Medicines for cluster headache prevention include:
- Verapamil (Calan, Covera HS, Verelan). Your doctor may call this drug a calcium channel blocker. It's also used to treat high blood pressure and chest pain.Verapamil cuts down on how many headaches you get. It can take a while to start working. So in the meantime, you may also need to take other preventive medicines that work faster, such as steroids.
- Topiramate (Topamax). This drug is also used to treat epilepsy. Your doctor may combine it with other preventive meds, such as verapamil or steroids.
- Corticosteroids (steroids). Doctors also call these meds, which include prednisone, "glucocorticoids." They work faster than some other preventive options. These drugs may help if your headaches usually crop up during a period of less than 3 weeks. They come as pills, a shot, or through an IV. Your doctor will probably give them to you for a short while. If you take them for too long, they can cause weight gain, high blood pressure, high blood sugar, and other side effects.
- Lithium (Lithobid). A few small studies show that this drug can help cut the number of cluster headaches you get. But it's usually less helpful at preventing them if you take it over a long time. Lithium has many side effects and can be dangerous in large doses. So while you take it, you'll need to get regular tests to check the level of it in your blood, track your thyroid levels, and make sure your kidneys and liver work right.
CGRP Inhibitors. CGRP (calcitonin gene-related peptide) is a molecule involved in causing migraine pain. CGRP inhibitors are a new class of drugs that block the effects of CGRP. Erenumab (Aimovig) and fremanezumab (Ajovy) are specifically approved to prevent migraine attacks. You give yourself an injection once a month with a pen-like device.
Researchers are studying other medicines to prevent clusters. These include melatonin, capsaicin, and valproic acid. If you can't take other medicines for prevention, or they don't stop your headaches, your doctor may suggest that you try one of these.
If you have chronic cluster headaches and medicine doesn't help, a nerve block may be an option. It's a shot of anesthetic medicine that is sometimes combined with steroids. It stops the pain by blocking or numbing the nerves connected with cluster headaches. You get the injection in the back of your head.
There are a couple of devices designed to interupt the lectrical impulses in your brain that triggers cluster headaches. A device called SpringTMS or eNeura sTMS uses a technique called a transcranial magnetic stimulation (TMS). Place it on the back of your head for about a minute for release of a pulse of magnetic energy. Similarly, Cefaly uses transcutaneous supraorbital nerve stimulation and is worn as a headband on the forehead and turned on daily for 20 minutes to prevent migraine from developing. There is also a noninvasive vagus nerve stimulator called gammaCore. When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.