Cluster Headache TreatmentsCluster headache treatments must be very fast. This is because Cluster headaches generally come on so rapidly and so severely, that very fast-acting treatments are required. Medications that are administered through injection or through an intranasal route have a distinct advantage over pills. First-Line TherapiesI usually have patients try Imitrex subcutaneous injections (Imitrex SQ 4mg or 6mg) if their headaches come on very rapidly. This is available in a prepackaged needle which allows patients to easily give themselves an injection just below the skin. Many patients tell me that they get relief within 10 minutes of the injection – which is much faster than a pill can work.There are three intranasal medications that can be used for cluster headache treatment. While not as rapid or as effective as Imitrex SQ, some people who are needle-phobic may want to try them. I would typically start with Imitrex Nasal Spray (NS) or Zomig Nasal Spray (NS); then have patients try Migranal Nasal Spray (NS) if the first two are not effective. Inhaled oxygen is also very effective, and can work in many patients as fast as 7 minutes. Patients are usually provided with a portable oxygen canister and a face mask. At the onset of headache, they put on the face mask and breath 100% oxygen (at a rate of 7 Liters/minute) for about 15 minutes. Because oxygen is flammable and the cannisters can be large, it is clearly not as convenient as other options. Many patients have it at home, in the bedroom, and use it if they awaken with a headache. Second-Line TherapiesDihydroergotamine (DHE, the same medication as in Migranal NS) is also effective in an intravenous (IV) form. This is not very practical, though, since patients cannot expect to have an IV in their arms waiting for the next headache to occur. DHE can also be self-injected under the skin (SQ) or into the muscle (IM). These routes are effective, though headache relief is much slower than with the therapies already mentioned.I have never prescribed octreotide (a hormone therapy) for patients with cluster headaches, simply because other therapies have seemed to provide enough benefit. Literature suggests, though, that subcutaneous injections of this medication (100mcg) can work reasonably well for acute cluster headache attacks. Other injectable medications, including narcotics, might offer some benefit – but generally are not prescribed due to poor response (not enough headache benefit) and the possibility of developing rebound headaches from their overuse. Overall ApproachDon't just read this page and neglect prevention of your headaches. Neurologists want patients with cluster headaches to focus on preventative therapy as much as possible, including what is called transitional therapy (short-term therapy aimed at stopping headaches for a week or two while longer-term preventative therapy is allowed to work). This important and complicated aspect of therapy should never be neglected – please review Cluster Headache Prevention for more information.Return from CLUSTER HEADACHE TREATMENTS to CLUSTER HEADACHES
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