Cluster headaches occur in bouts of intensely painful daily headaches for weeks at a time, followed by months of remission in which the headaches totally subside. During a cluster headache, acutely acting treatments can shorten its duration and ease the pain. To prevent subsequent headaches, a patient can try temporary preventive treatments until the effects of longer lasting but slower acting treatments take hold. Other treatments including surgery or brain stimulation might be an option for extreme cases.
Acute Treatments
According to the Merck Manual, a typical cluster headache lasts from 30 minutes to an hour. Aspirin, ibuprofen or similar over-the-counter pain relievers are not effective for cluster headache because the pain usually subsides on its own before they can take effect, says the Mayo Clinic. Faster acting treatments include oxygen therapy and several medications available as injections, nasal sprays or inhalers.
The Mayo Clinic claims that breathing pure oxygen through a mask provides relief from a cluster headache within 15 minutes. Two triptan drugs, sumatriptan and zolmitriptan, and dihydroergotamine can relieve cluster headaches. A synthetic version of the hormone somatostatin or a local anesthetic like lidocaine can also treat acute cluster headaches.
Preventive: Short-Term
Short-term preventives reduce the likelihood of a cluster headache, but are only used until slower acting but longer lasting preventive measures can take effect. Corticosteroids like prednisone can suppress cluster headaches but have serious side effects that prohibit their long-term use. Ergotamine as a tablet or rectal suppository can prevent nighttime headaches. Injection of a nerve-blocking agent can temporarily disable the nerve fibers that transmit the sensation of pain.
Preventive: Long-Term
People with cluster headaches need to take long-term preventives during the whole cluster period because the onset of a headache cannot be predicted. According to the Mayo Clinic, a calcium-channel blocked called verapamil is often the first choice for a long-term preventive medication. Other options include lithium carbonate and anti-seizure drugs like divalproex and topiramate.
Surgery
Only people who have headache symptoms always on the same side of the head and who cannot tolerate other treatments are candidates for surgery. The Mayo Clinic describes conventional surgery that cuts part of the nerve behind the eye, but does not recommend it due to the risk of injury to the eye. In a less risky option, a surgeon can inject glycerol into nerves serving the face.
Brain Stimulation
A type of treatment for cluster headache involves surgical implantation of a stimulator that sends electrical impulses to the nerves involved with pain or to hypothalamus, the area of the brain that controls the daily rhythms of cluster headache onset. The Mayo Clinic says that these devices work for some people with severe cluster headaches.
