Headaches: Cluster - Medications

Corticosteroids. A corticosteroid is very useful as a transitional agent for stabilizing patients after an attack until a maintenance agent, such as a calcium-channel blocker, begins to take effect. The corticosteroid drug prednisone is effective in up to 90% of patients with episodic cluster headaches. The drug is typically taken for a week and then gradually tapered off. If headaches return, then it may be administered again. Unfortunately, long-term use of steroids can lead to serious side effects so they cannot be taken for on-going prevention.

text continues below

Other Drugs Investigated for Prevention

Baclofen (Lioresal). Baclofen is a drug that relaxes muscle spasms. Small studies are reporting some success. For example, in a 2001 study, 12 out of 16 patients reported an end of attacks within a week and another one became headache-free by the second week. (The remaining three patients became worse, however, and required other agents.) Three of the patients who improved experienced an additional cluster cycle, which cleared when they took another course of baclofen.

Botulinum. Botulinum toxin A (Botox) injections are being used for a number of conditions requiring muscle relaxation, including smoothing wrinkles. (This potentially deadly toxin is very safe when minuscule amounts are injected into small muscles.) Botox has shown promise for migraine and tension headache sufferers and is now being studied for cluster headaches as well. It is too early yet to gauge any real benefits.

Alternative Therapies

Melatonin. Small reports indicate that melatonin, a brain hormone that helps to regulate the sleep-wake cycle, may help prevent episodic or chronic cluster headaches. Melatonin supplements are sold in health food stories, but as with most natural remedies, the quality of different preparations varies, and they have not been rigorously tested for safety or effectiveness. Hormones such as melatonin are powerful substances, and additional studies are needed.

Glucosamine. There have been some reports that glucosamine, an alternative remedy commonly used for osteoarthritis, may prevent migraine attacks. Some researchers theorize this substance may reduce inflammation that affects nerves involved in vascular headaches. Whether this agent has any effect on cluster headaches is unknown.

Additional Therapies. Many patients with cluster headaches try alternative remedies for relief of pain. Treatments may include acupuncture, herbs, chiropractic, homeopathic remedies, reflexology, hypnosis, spiritual therapies, massage, aromatherapy, relaxation techniques, and yoga. A 2002 survey of patients attending a headache clinic or support groups, however, did not find any of these alternative therapies to be consistently effective.