Treatment for Cluster Headaches

Treating cluster headache involves addressing the severe, sometimes unbearable, pain during the headache, and disrupting or shortening the cluster episode to prevent other episodes. Acute treatment medications include the following:

  • Sumatriptan (e.g., Imitrex), which can be given in injectable or nasal form for rapid onset; other oral triptans may also be effective
  • DHE (Migranal)—delivered as a nasal spray, can have a rapid onset and also available in an injectable form; side effects include nausea and dizziness (This medication may be dangerous if it is taken with sumatriptan.)
  • Steroid medications (prednisone)—usually prescribed at a high dose and gradually decreased over several weeks
  • Narcotics may be helpful, although for most patients, these pain relievers take too long to work, given the severity and duration of cluster headaches.
  • Breathing 100 percent oxygen during the acute headache can be helpful for some people. When the diagnosis of cluster headaches is made, and other medications do not work well, a tank of oxygen can be kept for home use.

People with cluster headaches should avoid triggers such as alcohol, cigarette smoking, and certain foods. Many patients find it helpful to keep a journal of their symptoms and a list of foods, drinks, medications, and sleep patterns, and other lifestyle information (e.g., stress levels, exercise).

Other drugs that may be used treat cluster headaches include:

  • Amitriptyline
  • Antiseizure medication (topiramate, valproic acid)
  • Calcium channel blockers (verapamil)
  • Cyproheptadine
  • Indomethacin
  • Lithium carbonate
  • Naproxen
  • Propranolol

In rare cases of severe cluster headaches that do not respond to medications, surgery on certain nerve cells may be performed.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Jan 2002

Last Modified: 18 Sep 2015