Medicines for Cluster Headaches

Topic Overview

Medicines may stop a cluster headache after it starts and prevent more headaches from occurring. Finding the right medicine can take some time. You may need a combination of medicines to effectively treat your cluster headaches.

Medicines and treatments that stop cluster headaches after they start

Treatments most often used to stop cluster headaches include:

• High-flow oxygen inhalation therapy, in which 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, which can be given as a shot, sprayed in the nose, or taken by mouth as a pill to reduce pressure and pain.
• Octreotide, which can be used as a shot to stop headache pain.
• Lidocaine, which is taken by nose drops to stop severe headache pain.
• Ergotamine preparations, which can be given as a pill or in a vein to relieve pressure and reduce headache pain.

Medicines that prevent cluster headaches during a cluster period

Medicines that prevent cluster headaches during a cluster period include:

• Corticosteroids, such as prednisone. These medicines are used to stop cluster headaches for a short time. These medicines give you some relief from headaches while preventive medicines start to work. Corticosteroids are not used as preventive medicines long-term because of bad side effects.
• 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.
• Antiseizure medicines, such as valproate. These may be tried if other treatments are not effective.
• 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.

What to think about

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

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.

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. Keeping track of your symptoms can help your doctor determine the proper medicine. You can keep track by using a headache diary (What is a PDF document?).

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.

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.