Headache Education Center

Cluster headache


Description
Treatment
Links



Treatment


  1. Abortive: What to take “as needed” for a headache. The earlier the medicine is taken, the more effective it will be. These are the medications used most commonly, although this is not an all-inclusive list. At the onset of a cluster cycle a course of Prednisone is often started.
    1. Oxygen therapy by portable oxygen tank and a non-rebreather facemask with 100% oxygen at 10-15 liters/minute for 15-20 minutes at the onset of a cluster headache
    2. Triptans:
      ---Sumatriptan injection (Imitrex, Sumavel, Alsuma), nasal spray (Imitrex), breath- powered intranasal delivery system (Onzetra Xsail)
      ---Zolmitriptan (Zomig) nasal spray
    3. Ergots:
      ---Dihydroergotamine (DHE) given as self-injections, through an IV coordinated with your doctor, or by nasal spray (Migranal). There is an inhaled form that may eventually become available.
    4. Devices:
      ---GammaCore®️ (non-invasive vagus nerve stimulator)
    5. Others:
      ---The ClusterBusters Method of using Tryptamines at sub-hallucinogenic dosing ("microdosing"): Psilocybin, lysergic acid amide (LSA), lysergic acid diethylamide (LSD), (see ClusterBusters link on next page; be aware of potential legal ramifications of these treatments)
  2. Preventive: What to take on a daily basis to try to lessen the frequency and/or severity of the headaches. These are the medications used most commonly, although this is not an all- inclusive list.
    1. Anti-hypertensive (blood pressure) medications:
      ---Verapamil (Calan) (This is often the first line “gold standard” choice, started at the beginning of a cluster headache cycle at a three times daily dose interval.)
    2. Anti-convulsant (Anti-seizure) medications:
      ---Divalproex sodium (Depakote)
      ---Topiramate (Topamax)
    3. Anti-depressants:
      ---Lithium
    4. Others:
      ---Occipital nerve blocks (this can sometimes help to break up a cycle)
      ---SPG (sphenopalatine ganglion) blocks or neurostimulation
      ---Melatonin
      ---The ClusterBusters Method of using Tryptamines at sub-hallucinogenic dosing ("microdosing"): Psilocybin, lysergic acid amide (LSA), lysergic acid diethylamide (LSD), (see ClusterBusters link on next page; be aware of potential legal ramifications of these treatments)
    5. Biologics:
      ---CGRP (Calcitonin Gene Related Peptide) Antagonists: Emgality (Galcanezumab)