Treatment Overview
While there is no cure for cluster headaches, treatment can effectively reduce the frequency and severity of your headaches. You don't have to live with the excruciating pain of these headaches. Treatment depends on the frequency of headache cycles and the severity of symptoms during a cycle.
Initial treatment
Treatments to stop cluster headaches that have already started are called abortive headache treatments. They include abortive headache medicines and an oxygen therapy. Abortive treatments relieve pain and reduce the severity of symptoms once the headaches begin. Abortive headache treatments used most often to stop a cluster headache 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, in which you breathe oxygen through a face mask to reduce blood flow to the brain and relieve headache pain. Around 7 in 10 people treated with oxygen soon after the start of a headache get relief within 10 to 20 minutes.3 But you need to repeat the treatment when the next headache begins.
- Intranasal lidocaine, which is taken by nose drops to stop severe headache pain.
- Sumatriptan (Imitrex), which is usually 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.
Medicines used to prevent cluster headaches or reduce the number of headaches in a cycle are called prophylactic headache medicines. Prophylactic headache medicines most often used to prevent cluster headaches include:
- Calcium channel blockers, such as verapamil hydrochloride (Calan, Isoptin, Verelan), which widen 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.
It may be helpful to identify and avoid headache triggers such as alcohol, cigarettes, and raising your body temperature with hot baths or exercise during a headache cycle. For more information, see:
Keep track of when your cluster headaches happen, how often they happen, how severe your symptoms are, and what you think may be causing the headaches. Write it all down in a headache diary
(What is a PDF document?). Take this written record with you when you visit your doctor, because it can provide valuable information to guide your treatment.
Headaches sometimes require imaging tests, but it is rare that headaches are the only symptom of a brain tumor. If your symptoms do not clearly indicate cluster headaches, your doctor may recommend imaging tests (such as a CT scan or an MRI) to rule out other possible causes of the headaches. Talking with your doctor can help you decide whether imaging tests are right for you. For more information, see:
Ongoing treatment
Ongoing treatment for cluster headaches usually includes taking prescribed medications and avoiding headache triggers. It may take several attempts with different medicines before you find the right one. If a medicine is not preventing or stopping your headaches, talk with your health professional to see whether another medicine or a combination of medicines might work better.
Abortive headache treatments are often used to stop a headache after a cycle of cluster headaches begins. Those most often prescribed 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, in which you breathe oxygen through a face mask to reduce blood flow to the brain and relieve headache pain. Around 7 in 10 people treated with oxygen soon after the start of a headache get relief within 10 to 20 minutes.3 But you need to repeat the treatment when the next headache begins.
- 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.
If your cluster headaches come back often or become chronic, you may want to consider taking a prophylactic headache medicine to reduce the frequency of headache cycles or limit the number of headaches you get during a cycle. Prophylactic medications most often used to prevent headaches include:
- Calcium channel blockers, such as verapamil hydrochloride (Calan, Isoptin, Verelan), which widen 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. Because of possible serious side effects, corticosteroids are not used for long-term treatment.
- 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.
Identifying and avoiding headache triggers is another way to help prevent or reduce the number of recurring cluster headaches during a cycle of headaches. Avoiding alcohol, cigarettes, and certain foods (such as aged cheeses and processed meats) may help reduce the number of headaches you have during a cycle. For more information, see:
Keep track of when your cluster headaches happen, how often they happen, how severe your symptoms are, and what you think may be causing the headaches. Write it all down in a headache diary(What is a PDF document?). Take this written record with you when you visit your doctor, because it can provide valuable information to guide your treatment.
If your headaches are not relieved by medications or their pattern changes, your health professional may recommend imaging tests to rule out other causes of your headaches. Talking with your health professional can help you decide whether imaging tests are right for you. For more information, see:
Chronic, excruciating, and debilitating cluster headaches can cause depression and even thoughts of suicide during the headaches. For this reason, cluster headaches are sometimes referred to as "suicide headaches." If your headaches are so painful you feel depressed or suicidal, talk to your health professional. Knowing the severity of your symptoms will help your health professional prescribe the best treatment.
Treatment if the condition gets worse
If your cluster headaches worsen, change their pattern, or become chronic, you may want to talk to your health professional about different treatments. By keeping a headache diary(What is a PDF document?), you can help identify the pattern of your headaches so you become aware of any changes and can discuss them with your health professional.
Sometimes changing medications is all that is needed. It is possible you may need to try a prophylactic medication to prevent headaches rather than an abortive medication to stop the headaches as they occur.
If your headaches are severe or frequent, you may want to ask your health professional about trying high-flow oxygen inhalation therapy. Breathing in 100% oxygen through a face mask soon after a headache begins can eliminate or greatly reduce pain for many people within 10 to 20 minutes. However, the procedure must be repeated when the next headache in the cycle of headaches begins. While oxygen therapy is helpful for many people, it is not effective for everyone.
If your headache pattern changes, headaches become worse, or are not helped with medications, your health professional may recommend imaging tests to rule out other causes of your headaches. Talking with your health professional can help you decide whether imaging tests are right for you. For more information, see:
Other rare treatment
Surgery and radiation may be considered after other medical treatments have failed to improve cluster headaches. Because surgery and radiation can cause significant, destructive changes in the brain, these treatments are rarely used. Further study on surgery and radiation therapy for the treatment of cluster headaches is needed to prove any effectiveness.6
What To Think About
You may need to try several different medications or a combination of medications before finding the most effective treatment. If your headaches occur infrequently, you may only need to take medications as the headaches emerge. If your headaches occur regularly, you may need to take daily medications to prevent a future headache or reduce the number of headaches in a cycle.
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