Treatment:

Treatment does not cure cluster headaches. The goal of treatment is to relieve symptoms. The headaches may go away on their own, or you may need treatment to prevent them.

Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided. A headache diary can help you identify your headache triggers. When you get a headache, write down the day and time the pain began. The diary should include notes about what you ate and drank in the last 24 hours, how much you slept and when, and what was going on in your life immediately before the pain started. For example, were you under any unusual stress? Also include information about how long the headache lasted, and what made it stop.

Treatment for cluster headaches involves:

• Methods to treat the pain when it happens
• Medicines to prevent the headaches

Your doctor may recommend the following treatments for when the headaches occurs:

• Triptans, such as sumatriptan (Imitrex)
• Several weeks of anti-inflammatory (steroid) medicines such as prednisone -- starting with a high dose, then gradually decreased
• Breathing in 100% (pure) oxygen often relieves cluster headache for some people, particularly for frequent cluster headaches that occur at night
• Injections of the drug known as dihydroergotamine (DHE), which can stop cluster attacks within 5 minutes (Warning: this drug can be dangerous if taken with sumatriptan)

A combination of medicines may be needed to control headache symptoms. Because each person responds differently to medicine, your doctor may have you try several medications before deciding which works best for you.

Painkillers do not usually relieve the pain from cluster headaches. Generally, they take too long to work.

The following medications may also be used to treat or prevent headache symptoms:

• Antiseizure medications such as topiramate and valproic acid
• Indomethacin or naproxen
• Lithium carbonate
• Calcium channel blockers such as verapamil
• Propranolol
• Amitriptyline
• Cyproheptadine

In rare cases, surgery on certain nerve cells near the brain may be recommended if medications do not work.

Expectations (prognosis):

Cluster headaches are not life-threatening and usually cause no permanent structural changes. However, they are chronic and often painful enough to interfere with work or lifestyle. Occasionally, the pain may be so severe that some people may consider self harm.

Side effects of medications or surgery may be severe.

Complications:

• Headaches that interfere with daily activities
• Horner syndrome
• Side effects of medications
• Complications due to surgery to treat the headaches, including:
  • Permanent muscle weakness in the face or head
  • Decreased sensation in parts of the face or head

Calling your health care provider:

Call for an appointment with your health care provider if cluster headaches do not respond to treatment, if headaches disturb sleep, if they happen whenever you are active, or are accompanied by other symptoms.

Emergency symptoms include drowsiness, vision changes, changes in movement or sensation, seizures, changes in alertness, and nausea or vomiting.