Medicines for Cluster Headaches

Overview

Medicines may stop a cluster headache after it starts or prevent more headaches from occurring. If you don't get headaches often, you may only need to take medicines after the headaches begin. If you get headaches often, you may need to take medicines daily during a cluster period to prevent a future headache or reduce the number of headaches in a cycle.

The choice of medicine may depend on the time of day when your headaches tend to occur. Some people may need a combination of two or three medicines. Finding the right medicine can take some time. Keeping track of your symptoms can help your doctor determine the proper medicine. You can keep track by using a headache diary.

When a cluster headache occurs, it is important to treat it as early as possible with the medicine your doctor has recommended. The sooner you treat the headache, the less painful it may be.

If your headaches become more severe and medicines aren't working, let your doctor know. You may need to try a different medicine or a combination of medicines. You may also need to be referred to a hospital or headache clinic for more intensive treatment.

Experts do not recommend opioid medicines, like oxycodone or hydrocodone, to treat cluster headaches. They can have harmful side effects.

To stop a cluster headache

Treatments most often used to stop cluster headaches include:

High-flow oxygen inhalation therapy.

You breathe oxygen through a face mask to relieve headache pain. Oxygen therapy is one of the best treatments to stop a cluster headache. Oxygen therapy relieves headache pain within 15 minutes in more than 7 out of 10 people who use it. It works best when started right when a cluster headache starts.footnote 1 But you need to repeat the treatment when the next headache begins.

Triptans.
Triptans can be given as a shot, sprayed in the nose, or taken by mouth as a pill to reduce pressure and pain.
Octreotide.

Octreotide can be used as a shot to stop headache pain.

Lidocaine.

Lidocaine is taken by nose drops to stop severe headache pain.

Ergotamine preparations.

These can be given as a pill or in a vein to relieve pressure and reduce headache pain.

Over-the-counter pain medicines, such as aspirin, acetaminophen, and ibuprofen, usually don't relieve the severe pain of cluster headaches.

To prevent headaches during a cluster period

Some medicines that prevent cluster headaches during a cluster period include:

Suboccipital steroid injection.

This medicine is used to reduce the number of headaches in a cluster cycle. These may be given either as a single injection or a series of injections.

Verapamil.

This medicine is used to prevent or reduce the number of headaches in a cluster cycle. Verapamil is commonly used for preventing both occasional and chronic cluster headaches.

Lithium.

This medicine is often prescribed to prevent chronic cluster headaches.

Ergotamine.

This medicine can be used at bedtime to prevent cluster headaches overnight.

You must take these medicines every day during a cycle of headaches, even on days when you don't get a headache.

Related Information

References

Citations

  1. Cohen AS, et al. (2009). High-flow oxygen for treatment of cluster headache: A randomized trial. JAMA, 302(22): 2451–2457.

Credits

Current as of: December 13, 2021

Author: Healthwise Staff
Medical Review:
Anne C. Poinier MD - Internal Medicine
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
Karin M. Lindholm DO - Neurology

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