Cluster headaches are some of the most intense and debilitating forms of headaches. Defined by severe, unilateral pain, cluster headaches present in clusters or cycles, which usually endure for weeks or months before entering remission. Although their irregularity makes them difficult to predict, the aim of cluster headache treatment is to lower the frequency and severity of attacks, provide relief during attacks, and treat symptoms for those who have chronic cases. Here in this blog, we are going to discuss several treatment strategies for cluster headaches ranging from acute relief interventions to preventive long-term interventions and possible future treatments.
Cluster Headache Treatment: Understanding the Options
There is as yet no cluster headache cure. Nevertheless, medicines are available which can alleviate symptoms and make the condition more controllable. The treatment typically fits into two broad categories: acute (abortive) treatments and preventive treatments. Acute treatments are intended to abort a developing cluster headache once it has commenced, whereas preventive treatments are geared to decrease attack frequency and intensity during a period of clusters.
Cluster Headache Medications: Relief of Acute Pain
The pain of a cluster headache is usually sudden and severe, making it hard to treat. Rapid-acting medications are usually the best at bringing relief. These medications act quickly to relieve the pain, with some acting almost instantly.
Oxygen Therapy: Oxygen therapy is one of the most successful forms of acute management for cluster headache. Inhaling pure oxygen via a face mask can make many people pain-free within 15 minutes of treatment. There are no recognized side effects for oxygen, meaning it is also safe for use in most patients, although people with severe COPD should avoid it.
Triptans: Triptans, including sumatriptan (Imitrex), are a standard treatment for acute relief from cluster headaches. Sumatriptan is most often given as an injection, which provides more rapid absorption and relief than the oral versions of the drug. Other triptans, including zolmitriptan (Zomig), can be taken in nasal spray form, though they are not as rapid-acting as the injectable form.
Octreotide: This drug, a synthetic version of the brain hormone somatostatin, is also of benefit to some patients with cluster headaches. Octreotide is given by injection and can be of benefit to those who do not respond to triptans.
Local Anesthetics: Local anesthetics, including lidocaine, are relievers from some individuals with cluster headache pain. Local anesthetics are delivered via the nose.
Dihydroergotamine: This drug, which can be administered intravenously, may relieve some people with cluster headache pain. It also comes in a nasal spray, but the nasal form has not been shown to be effective for cluster headaches.
Preventive Treatment for Cluster Headaches
Preventive therapies are designed to decrease the number and severity of cluster headaches during a cluster period. These drugs are usually initiated at the beginning of a cluster headache cycle and are maintained until the cycle terminates. After the cluster period, the drug is tapered off.
Calcium Channel Blockers: Verapamil (Calan SR, Verelan) is a widely prescribed calcium channel blocker that is often used to prevent cluster headaches. It is a calcium channel blocker that can regulate blood flow and decrease the number of attacks. Verapamil is usually the first-line preventive medication for cluster headaches, but it might be combined with other drugs. Verapamil's side effects might include constipation, nausea, tiredness, and irregular heartbeat.
Corticosteroids: Prednisone (Prednisone Intensol, Rayos) is a corticosteroid with the ability to bring quick relief for cluster headache. It usually serves as short-term relief medication for individuals suffering from infrequent or short bursts of cluster headache. Although potent, corticosteroids need not be prescribed for extended intervals because of potential severe side effects, including diabetes, hypertension, and osteoporosis.
Galcanezumab (Emgality): This newer drug has just been approved by the FDA for the management of episodic cluster headaches. Galcanezumab is injected once monthly and functions by blocking a molecule that is part of the pain signal, thereby preventing attacks throughout the cluster phase.
Lithium: Lithium, which is normally prescribed for treating bipolar disorder, can also be beneficial in the prevention of chronic cluster headaches.
Noninvasive Vagus Nerve Stimulation (VNS): VNS therapy involves a portable device that sends electrical impulses to the vagus nerve, which is believed to be implicated in cluster headaches. There is some evidence that VNS reduces the frequency of attacks, but more research is needed to confirm its long-term efficacy.
Nerve Blocks: In a general manner, nerve blocks, and more precisely occipital nerve blocks, can give temporary relief. The method involves the injection of local anesthetic and corticosteroid into the area of the occipital nerve, located at the back of the head.
Cluster Headache Treatments for Chronic Cases
Year-round cluster headaches that are not interrupted by long periods of remission can be especially difficult to treat. In such instances, the aim is to minimize the number of attacks and control pain. Preventive medications, including verapamil and lithium, are usually combined to manage chronic cluster headaches. Other treatments, such as nerve stimulation or occipital nerve blocks, can also be employed for long-term management.
New Cluster Headache Medications and New Therapies
The research for new drugs and therapies for cluster headaches continues. Besides galcanezumab, researchers are testing other potential treatments, including monoclonal antibodies and neurostimulation therapies like deep brain stimulation (DBS) and sphenopalatine ganglion (SPG) stimulation. These therapies involve the implantation of a device in certain parts of the brain to interrupt pain messages, and the initial findings are encouraging.
Although these therapies are still under research, they bring hope to those who do not yield to conventional treatments.
Cluster Headache Surgery Options
Surgery can occasionally be done on people who suffer from chronic cluster headaches that have not been responsive to other interventions. Surgical techniques are intended to destroy the nerve pathways that are believed to transmit the pain. Surgery poses large risks, however, such as weakness in muscles of the jaw and facial numbness and paresthesias of the head and face, and it is unclear what benefits surgery would produce for cluster headache in the long term.
