Which medications are used the treatment of pain management, prevention, and other symptoms of cluster headaches?

The treatment of cluster headache can be divided into two distinct categories — relief of the acute headache and prevention of future headaches.

Oxygen deliverey: Delivering oxygen by a face mask has been shown to help a majority of people within a short period of time. However, this can be unwieldy, and most people are unable or unwilling to transport oxygen canisters if they need to travel.

Injectable sumatriptan (Imitrex, Alsuma, Samavel DosePro) has been shown to be beneficial in many of patients with cluster headache. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable.

Dihydroergotamine, given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours.

Intranasal lidocaine has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly.

Steroids can be extremely effective to decrease a headache cycle. Steroids should not be used frequently, and are for short-term use only as long-term use can lead to significant complications.

Verapamil (Calan, Varelan), lithium (Lithobid, Eskalith), valproic acid (Depakote, Stavzor), topiramate (Topamax, Quedxy, Topiragen, Trokendi XR), and melatonin can all be of benefit in reducing the frequency and severity of cluster cycles.

Surgery for intractable cases has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency, but is associated with significant side effects and nerve loss.

Gamma knife lesioning and deep brain stimulation are being studied as possible options with less risk of permanent nerve change.