Treatment of Cluster Headaches
Treatment of cluster headaches focuses on relieving pain quickly during an attack and preventing future episodes. Because cluster headaches are so intense, immediate and effective intervention is essential. There are three main pillars of management: acute treatment, preventive treatment, and lifestyle modifications.
1. Acute Treatments (Abortive Therapy)
The goal is to stop pain rapidly once an attack begins:
- Oxygen therapy: Inhaling 100% oxygen at 12–15 litres per minute via a face mask for 15–20 minutes can abort attacks quickly in many patients.
- Triptans: Injectable sumatriptan or nasal zolmitriptan are effective for halting attacks. Oral tablets are generally too slow-acting.
- Intranasal lidocaine: A local anaesthetic applied inside the nostril on the affected side may help shorten attacks.
2. Preventive Treatments | Treatment of Cluster Headaches
These are started at the onset of a cluster period to reduce frequency and severity:
- Verapamil: A calcium channel blocker and the most widely used preventive. Doses are increased gradually and monitored via ECG due to heart rhythm risks.
- Lithium: Effective in chronic cases but requires blood monitoring.
- Corticosteroids: A short course of prednisone can help break a cluster cycle.
- Nerve blocks: Injections of anaesthetic and steroid near the occipital nerve may reduce attack frequency.
3. Newer and Surgical Options
For resistant cases, options include:
- Galcanezumab (a CGRP inhibitor)
- Deep brain stimulation (experimental)
- Sphenopalatine ganglion stimulation via implanted devices
4. Lifestyle Changes | Treatment of Cluster Headaches
Although not causes, triggers such as alcohol, strong smells, and irregular sleep can worsen symptoms. Maintaining a consistent daily routine and avoiding known triggers during active periods is essential.
With the right combination of abortive and preventive therapies, the treatment of cluster headaches can significantly improve quality of life. Early intervention and specialist care are crucial for long-term success.
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