Cluster headaches can't be treated with over-the-counter painkillers, such as paracetamol, as they're too slow to take effect. You'll need to be treated at a specialist clinic.
There are two main types of treatment:
- those that relieve cluster headaches
- those that prevent cluster headaches
Relieving cluster headaches
Sumatriptan
A drug called sumatriptan (Imigran) is commonly used to treat cluster headaches. It works in a similar way to a brain chemical called 5HT. It causes your blood vessels to narrow, reducing bloodflow to the brain.
Sumatriptan is usually given as an injection, which you can give yourself as soon as the headache starts. It works very quickly (within about 10 minutes).
The adult dose in an injection is 6mg and you can take a maximum of two injections in 24 hours, as long as they're at least an hour apart.
If an injection is unsuitable, sumatriptan or zolmitriptan nasal spray may be used.
Some people have mild side effects, such as nausea, dizziness, tiredness and a dry mouth. If you have any side effects, talk to your GP. You shouldn't take it if you have heart disease or peripheral vascular disease.
Oxygen therapy
Your doctor may prescribe oxygen cylinders to use at home. You breathe a high flow of pure oxygen through a mask for about 15 minutes, up to five times a day. It's a safe treatment and there's evidence that it is effective in relieving cluster headaches.
Preventing cluster headaches
If attacks of cluster headaches happen often or last for more than three weeks, preventative treatments are usually necessary. This involves starting treatment as soon as the headaches begin, and taking it every day throughout the period of headaches until they end.
Preventative treatments must only be administered under the guidance and close monitoring of a specialist. Treatments are outlined below.
Verapamil
Verapamil tablets are usually used to treat heart problems but are also effective at preventing cluster headaches. The heart must be closely monitored with ECGs (electrocardiograms) when the dose of verapamil is increased.
Lithium
Lithium tablets are normally used to treat mood disorders, but can help cluster headaches. The level of lithium in your blood may need to be carefully monitored to avoid side effects.
Methysergide
Methysergide tablets are effective at preventing cluster headaches but should only be used when other treatment hasn't worked. Due to the risk of side effects, they shouldn't be used for longer than six months.
Occipital nerve anaesthetic block
The occipital nerve runs from the top of the spine to the scalp and is involved in the pain of cluster headaches. Occipital nerve block is the injection of a local anaesthetic, such as lidocaine, into the back of the head to relieve the pain of cluster headaches for a period of time (usually several weeks). Although there's a lack of research evidence on this treatment, it appears to provide relief for some patients.
