Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. Spontaneous remission may occur, or treatment may be required to prevent headaches.
Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided.
A headache diary may be helpful to identify such triggers. When a headache occurs, record the date, the time,and list any activities, substances used or consumed within the previous 24 hours and any other factors that seem significant.
Analgesic medications do not usually relieve the pain from cluster headaches. Generally, they take too long to work -- the headache is usually gone before they take effect.
Inhalation of 100% oxygen often relieves cluster headache for some people, particularly for frequent cluster headaches that occur at night.
Combination or multiple medications may be required to control symptoms of cluster headache. Because response to medications varies, several medications may be tried before a suitable treatment is found. Response can vary over time, so a previously taken effective medication or combination of medications may not have the same effect.
Ergot preparations (containing ergotamine tartrate alone or in combination with other medications) help prevent attacks for some people. The side effects, however, may be severe.
Methysergide maleate may be helpful to relieve pain and prevent attacks. It may also have severe side effects.
Other medications may be used to treat or prevent symptoms. These include the following:
- Antihistamines
- Indomethacin
- Lithium carbonate
- Calcium channel blockers
- Propranolol
- Amitriptyline
- Verapamil
- Methysergide
- Cyproheptadine
All preventive medications should be tapered off slowly during periods of remission (no headache).
Corticosteroid medications such as prednisone may provide short-term relief of cluster headaches in some people. They are not advised for long-term use because of side effects.
Surgery on certain nerve cells near the brain may rarely be recommended if medications are ineffective.
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