Managing Cluster Headaches:

Management of cluster headaches focuses on:

• Acute therapy for stopping an attack while it is happening
• Preventive therapy for stopping or reducing attack recurrences

Treating Attacks

The most effective and best-studied treatments for a cluster attack are:

• Oxygen inhalation
• An injection of the triptan drug sumatriptan (Imitrex)

Relief can occur in 5 - 10 minutes. Oxygen and sumatriptan injection are sometimes given together.

Other drugs that may be used for acute attacks are nasal sprays of dihydroergotamine or lidocaine.

Preventing Attacks

Cluster headache attacks are usually short, lasting from 15 - 180 minutes, and the excruciating pain may have subsided by the time a patient reaches a doctorâ ' s office or emergency room.

Because it can be difficult to treat attacks when they occur, , treatment efforts focus on the prevention of attacks during cluster cycles. Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.

Verapamil (Calan), a calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches. However, it can take 2 - 3 weeks for this drug to take effect. During this period, corticosteroids (typically prednisone) may be used as an initial transitional therapy. For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.

Although they are not approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin), are sometimes used for preventive treatment.

Behavioral Treatments and Lifestyle Changes

Behavioral Treatments. Behavioral therapies can be a helpful accompaniment to drug treatment. These approaches can help with pain management and enable patients to feel more in control of their condition.

Behavioral approaches include:

• Relaxation treatment combined with biofeedback
• Cognitive-behavioral therapy

Lifestyle Changes. Patients should avoid the following, as they may potentially trigger cluster headache attacks:

• Alcohol. Heavy alcohol use is strongly associated with cluster headaches, although it is not clear if alcohol triggers pain or is simply used as a coping mechanism for dealing with severe pain.
• Cigarette smoking. Many studies indicate that a majority of patients with cluster headache are cigarette smokers. While studies have not shown that quitting cigarettes will stop cluster headaches, smoking cessation should still be a goal. Smokers who can't quit should at least stop at the first sign of an attack and not smoke throughout a cycle.