Preventing Cluster Headaches
Preventive treatments for cluster headaches include the following:
- Calcium channel blockers (e.g., verapamil [Calan, Verelan]), which dilate blood vessels, are often the first choice for preventing cluster headaches and may be used in combination with other medicines. Verapamil can be taken twice daily in a sustained oral preparation. Side effects include nausea, dizziness, and constipation. The drug is typically used to treat angina, hypertension, and arrhythmias.
- Prednisone is a corticosteroid, a potent chemical that occurs naturally in the body. It is taken initially in high doses and then tapered over days or weeks, depending on the response. This medication is best if used for short periods of time. Long-term corticosteroid use can cause many serious adverse side effects because it is involved in several different functions in the body. Potential side effects include an increase in intraocular pressure, osteoporosis, behavioral changes, ulcer, and diabetes.
- Lithium carbonate may increase the levels of dopamine and norepinephrine in the brain. It is taken orally, usually twice a day, to interrupt a cluster headache. Concentration of lithium in the blood is closely monitored with periodic blood tests. Side effects include tremor, increased thirst, nausea, and frequent urination. Lithium carbonate typically is used to treat manic episodes in manic-depressive patients.
- Nerve block involves an injection of an anesthetic (numbing substance) and corticosteroid into the area of the occipital nerve. This treatment may be used to provide temporary relief until long-term treatments take effect.
- Ergots (e.g., ergotamine tablets, self-injected dihydroergotamine [DHE]) may be helpful if taken early in a cluster headache attack.
- Some studies have shown that 10 mg of melatonin taken in the evening before bed may help prevent cluster headaches.
- Seizure medications like devalproex (Depakote) and topiramate (Topamax) also may be helpful.
In rare cases that don't respond to other treatment methods, surgery to alleviate cluster headaches may be considered. This procedure involves damaging the trigeminal nerve pathway to disrupt pain signals. Because of the potential for severe side effectssuch as muscle weakness and sensory lossand questions about long-term benefits, this treatment is rarely used.