Acute Drug Treatment
The goal of treatment for cluster headache is to decrease the pain, severity, and duration of each attack. Early intervention is critical yet difficult, since a single cluster headache can be as short as 15 minutes. Non-oral route of administration for medications are therefore preferable.
Oxygen
Oxygen inhalation is the frst line therapy for cluster headache. Treatment is initiated with 100% oxygen at ma flow rate of 7 to 10 liters per minute. Teatment should continue for 15 minutes. Although up to 70% of patients experience relief within 5-10 minutes, some patients report that oxygen suppresses rather than aborts the attack and that pain may return. There are no side effects with this treatment.
Sumatriptan
Sumatriptan, 6 mg administered subcutaneously is an effective acute treatment for episodic and chronic cluster headaches, but it is most useful for patients who report 1 or 2 cluster attacks per day. Cluster attacks usually respond within 10-15 minutes. Smaller doses of 2 to 3 mg may also be enough to relieve the attacks. It should be used with a prophylactic so as to avoid dependancy.
Intranasal sumatriptan (20 mg) has been shown to have some efficacy but is generally regardsed as not being as effective as the subcutaneous injection.
Note that subcutaneous sumatriptan is avialable on a named patient basis only. View more information on Sumatriptan.
Prophylactic Drug Treatment
The 2 main goals of preventive treatment for cluster are:
To rapidly suppress individual attacks
Maintain that remission throughout the patient's typical cluster period.
Verapamil
Verapamil is the gold standard in the treatment of Cluster Headache. Treatment can be initiated at 120 mg daily and titrated up to 480 mg a day. Side effects are rare, but constipation is common. Other side effects include dizziness, nausea, edema, bradycardia, fatigue, and hypotension.
Corticosteroids
Prednisone (60mg a day) and Dexamethasone (4-8mg a day) are fast acting transitional prophylactic drugs that are used (usually in specialist centres) for Cluster headache prophylaxis.
Side effects include insomnia, restlessness, hyponatremia, edema, hyperglycemia, osteoporosis, myopathy, and gastric ulcers. The use of corticosteroids is discouraged in the long term in patients with chronic cluster headaches because the incidence of side effects increases with prolonged use.
Lithium
Sometimes used in specialist centres, Lithium carbonate has been shown to be effective against episodic and chronic cluster headaches. Of cluster headache patients, 78% of patients with chronic clusters and 63% of patients with episodic clusters respond to lithium. The usual daily dose ranges from 600 to 900 mg in divided doses. Side effects might include tremor, polyuria, and diarrhea. Nephrotoxicity and hypothyroidism can occur with long-term use.
