Preventative Medication Cluster Headache
Preventives are taken daily for a period of six to twelve months and while they rarely actually prevent attacks altogether, their success rate of about 50-60% means that it is likely you will experience at least some benefit.
The most common preventative treatments are:
- Verapamil research has shown that a daily dose can be effective in both episodic and chronic cluster headache. You may need to see a specialist in a hospital or clinic if you are prescribed this drug, because your heart will need to be monitored regularly using an ECG machine whilst the correct dose for you is established.
- Methysergide is effective in episodic (short term bouts) of cluster headache. Should not take this for more than six months at a time.
- Lithium at a low dose can be effective although again this will need careful monitoring. It is more effective in treating chronic cluster headache than episodic.
- Corticosteroids are fast acting and they can be used in a short burst for 2 to 3 weeks in decreasing amounts as a first step to break the cycle. . Corticosteroids are more effective for chronic cluster headache to break the cycle. If used for episodic cluster headache, when the medication is reduced the headaches come back.
- Ergotamine is infrequently prescribed. It can be helpful in reducing attacks at night if you take it at bedtime.
- Topiramate has recently been reported to be useful in cluster headache.
As with any drug treatment you may need to work with your doctor to determine what works best for you. You may need to try several treatment regimes before you discover the best one for you.
Preventative migraine medication is used in an attempt to reduce the frequency and severity of anticipated attacks. However, these drugs are unlikely to prevent attacks altogether and will not cure the underlying cause.
The goal of preventative treatments is to reduce the frequency of your migraine attacks. They are normally prescribed in one of the following circumstances:
- If you suffer from more than two or three attacks per month
- If your attacks are particularly severe or disabling and do not respond well to acute treatments
- To break the cycle of attacks
- If your attacks follow a regular pattern (e.g. around the time of menstruation)
- If you suffer from rare forms of migraine such as basilar or hemiplegic migraine
Preventatives will not be beneficial in treating an attack once it has started. Acute treatment is then necessary.
Some preventatives work better in one person than in another, so if one does not work well, it does not mean that another will not work.
The most commonly used migraine preventives include:
- Beta Blockers
- Anti-Epilepsy agents (Anti-Convulsants)
- Calcium Channel Blockers
- Tricyclic Anti-Depressants
- 5-HT Antagonists*