Cluster Headache: Treatment
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Treatment for cluster headaches is composed of induction, maintenance, and symptomatic therapies. The first two therapies are prophylactic treatments, geared toward preventing headaches. Symptomatic therapy is meant to stop or shorten a headache.
Induction and maintenance therapies begin together. Induction therapy is intended to break the headache cycle with drugs such as corticosteroids (for example, prednisone) or dihydroergotamine. These drugs are not meant for long-term therapy, but rather as a jump-start for maintenance therapy. Maintenance therapy drugs include verapamil, lithium carbonate, ergotamine, and methysergide. These drugs have long-term effectiveness, but must be taken for at least a week before a response is observed. With long-term treatment, methysergide must be stopped for one month each year to avoid dangerous side effects (formation of fibrous tissue inside the abdominal artery, lungs, and heart valves).
Despite prophylactic treatment, headaches may still occur. Symptomatic therapy includes oxygen inhalation, sumatriptan injection, and application of local anesthetics inside the nose. Surgery is a last resort for chronic cluster headaches that fail to respond to therapy.
— Julia Barrett
