Cluster headaches may be very difficult to treat, and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled , and additional headaches need to be prevented.
Initial treatment options may include the following:
* inhalation of high concentrations of oxygen (though this will not work if the headache is well established);
* injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well;
* injection of lidocaine, a local anesthetic, into the nostril;
* dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;
* caffeine
Preventative cluster headache treatment options may include the following:
* calcium channel blockers [for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS), diltiazem (Cardizem, Dilacor, Tiazac)]
* prednisone (Deltasone, Liquid Pred)
* antidepressant medications
* lithium (Eskalith, Lithobid)
* valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax) (often used for seizure control)