Table of Contents
Because it can be difficult to treat attacks when they occur, treatment efforts focus on the prevention of attacks during cluster cycles. Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.
Verapamil (Calan), a calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches. However, it can take 2 - 3 weeks for this drug to take effect. During this period, corticosteroids (typically prednisone) may be used as an initial transitional therapy. For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.
Although they are not FDA-approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin) are sometimes used for preventive treatment.
Behavioral Treatments and Lifestyle Changes
Behavioral Treatments. Behavioral therapies can be a helpful accompaniment to drug treatment. These approaches can help with pain management and enable patients to feel more in control of their condition.
Behavioral approaches include:
- Relaxation treatment combined with biofeedback
- Cognitive-behavioral therapy
Lifestyle Changes. Patients should avoid the following triggers that may provoke cluster headache attacks:
- Alcohol. Heavy alcohol use is strongly associated with cluster headaches, although it is not clear if alcohol triggers pain or is simply used as a coping mechanism for dealing with severe pain.
- Cigarette smoking. Many studies indicate that a majority of patients with cluster headache are cigarette smokers. While studies have not shown that quitting cigarettes will stop cluster headaches, smoking cessation should still be a goal. Smokers who can't quit should at least stop at the first sign of an attack and not smoke throughout a cycle.
Previous Section
Review Date: 09/29/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
