Cluster headache (CH) is a rare type of headache and is one of the most painful headache syndromes. Cluster headaches can affect each person differently, but there are two main groups of cluster headaches: episodic and chronic. Patients in the episodic group come in waves with daily or near daily headaches for weeks or months, followed by no headaches for months to years. This is the more common form and it’s where cluster headache gets it’s name: it’s as if the headaches are “clustering” together and then go away. Patients in the chronic group have daily or near daily headache with very few pain-free days.
Though there is currently no cure for cluster headaches, research is ongoing and each year new, innovative treatments become available.
Acute Attack Treatments
Oxygen
As one of the most effective treatments, oxygen is incredibly helpful in terminating attacks. It is administered by taking deep breaths from an oxygen mask. This is one of the safest and most natural approaches but you need a very high amount of oxygen, using a high flow (lots of air) and a specialized mask called a non-rebreather mask which ensures that you get pure oxygen with each breath.
Triptans
Medicines in the “triptan” family, especially sumatriptan and zolmitriptan, help to quiet down the brain’s overactive pain nerves. There are several ways to take these medications – injections, nasal sprays, and pills. Generally the faster the medication can get in, the better it works, so the injections are best, followed by nasal sprays, followed by pills.
Dihydroergotamine
Dihydroergotamine is an older, and in some ways more potent, version of the triptans. Can be administered through injections or a nasal spray. This approach is effective but is not recommended for consistent use because it can strongly constrict blood vessels. Thus, if used daily without a break, it could cause damage to the heart and other organs.
Lidocaine
Lidocaine comes in the form of nasal drops and is used to treat the pain of cluster headaches. It is a local anesthetic that works by blocking nerve endings to relieve relevant pain. Lidocaine treatment is valuable because it can be repeated after 5 minutes. It’s not a one-and-done deal, you have the option to readminister the dosage as needed.
Handheld electronic device for the neck (non-invasive vagus nerve stimulation)
More recently a device is available that is handheld and does not require surgery. The device is held on the side of the neck during a headache and activates the vagus nerve, which connects back to the pain system in the head. It does not use any medication, only electronic stimulation that can be turned up, down, or removed from the neck entirely.
Short-term Preventative Treatments
Steroids
Steroids are a type of bridge therapy, also called a “short-term preventative,” which involves a large dose of medication, typically prednisone, and then gradually decreasing the dosage over a couple of weeks. It creates a bridge between medication and preventative meditation to keep people out of pain. However, it should not be used often or for very long due to serious side effects.
Long-term Preventative Treatments
Verapamil
Verapamil treats high blood pressure and is commonly used as a cluster headache preventative. It relaxes the blood vessels and also changes firing of nerves in the brain. It has been shown to lower the number of headaches, their intensity, and how long they last.
Lithium Carbonate
Lithium is known for its treatment of bipolar disease (sometimes called manic-depression) but is also used for cluster headache. Lithium is thought to prevent certain types of cycling: the cycling between headache periods and headache-free periods in cluster headache, and the cycling between mania and depression in bipolar disease. Users of this method need to be monitored closely to ensure the Lithium in their blood does not exceed healthy levels.
Topiramate
Topiramate is a common treatment for seizures and migraine headaches, but has also been associated with improvements in cluster headache patients. It is administered daily and has been shown to cause remission quickly in some patients.
CGRP monoclonal antibodies
Calcitonin gene-related peptide antibodies (CGRP) are a more recent treatment for cluster headaches. This treatment targets a protein (CGRP) or the protein’s target (the CGRP receptor) to prevent pain signaling. This medication was first studied for migraine and has become a very popular option for both migraine and cluster headache, partly because it typically has very few side effects. It is administered through injections taken at home once per month.
What’s Best for You?
Each of these methods has its pros, cons, methods, and approaches, which is why it is important to talk to your doctor about which treatment is best for you. Identifying the type of cluster you suffer and the next steps is also important.
The Will Erwin Headache Research Foundation
The Will Erwin Headache Research Foundation was founded with the mission to find a cure for debilitating headaches. The articles we share and the research we do at The Will Erwin Headache Research Center are designed to help us toward this goal, as well as share updates with sufferers and provide them with hope. If you would like to contribute to the future of headache research and our mission, consider contributing today