This is the third post on a series about cluster headache.
Cluster headache treatments are similar to migraine treatment is that there are two parts: a preventive and an abortive. However, the rules for taking them are different than for those who have migraine.
Cluster headache preventives should be started as soon as a cycle starts. They don’t do much good taken when not in a cluster cycle and can do more harm than good. Like migraine, there are some herbal preventives as well as prescription preventives. There are people who need high doses and there are people who need a combination of medications to work.
An effective preventive will make the cluster headache sufferer no longer feel their headaches coming on. That doesn’t mean that the cycle is over. If you stop taking your preventives and the cycle isn’t over, you will feel the headaches again. This is a true “masking” of pain. What you have to do, is start tapering slowly after a month of being headache free – and please get your health care provider’s guidance on this! If the headache comes back, you are not out of cycle and should try again a few weeks later. If you don’t get a headache and you have discontinued the medication and do not have any headaches, then great! You are out of cycle. Note the medications and the dose that worked for you and have them ready for the next time that you are in cycle. Again, get your doctor’s help with this!
There is no way to make a cycle “go away”. You can mask it and that is almost like making it go away, but a real “go away” is not being on any medications and not feeling any pain. The cycle will last however long it lasts, typically a few weeks. Then, it will go away as mysteriously as it came. I know that is a bit confusing. What if you did not take a preventive? The cycle will still come and go as it may but you will experience the headaches. The preventives stop you from experiencing the headaches so that you aren’t in pain and you don’t have to treat them.
What are some preventives for cluster headache?
Melatonin
Kudzu (yes, the vine)
Verapamil
Lithium
Depakote
Topamax
Greater occipital nerve blocks with lidocaine/bupivicaine
Steroid tapers
Methylsergide
The other type of medication that is used for cluster headaches are the abortives. These are used when the headache is present to relieve the pain right then and there. If you get cluster headaches, you should talk to your doctor about getting both abortives and preventives. These are commonly:
Oxygen at 8L/min with a non-rebreather mask (you can get this for home use)
Imitrex
Zomig nasal spray
application of White Flower balm at the base of the nostrils
Opioids should be rarely used.
If you are going to see a new headache, TELL the receptionist when you book your appointment that you get cluster headaches. They often have special slots due to the intensity and shorter cycle of a cluster headache.
