Cluster Headaches

Treatment

Mayo Clinic doctors work closely with you to determine the most appropriate treatment for your cluster headaches. Your doctor will work with you to help you manage your pain, decrease the severity of your pain and shorten the frequency and length of your cluster headache periods. Your doctor will focus on treatment to help prevent cluster headaches. Cluster headache treatment may include several options.

Acute cluster headache treatment includes:

• Oxygen inhalation. Inhaling 100 percent oxygen through a mask may relieve your pain quickly.
• Triptans. These medications, given in an injectable form, often provide you with fast-acting relief of your pain. Sometimes these medications may be given in an inhaled form.
• Other medications and treatments. Other medications and treatments, including an injectable synthetic version of the brain hormone somatostatin (octreotide), a nasal drop form of local anesthetic (lidocaine), and the oral medication ergotamine, may help relieve your pain. Another drug, dihydroergotamine, may help relieve your pain when administered intravenously.

Preventive therapy

Your doctor may recommend that you take medications to help prevent cluster headaches, and your doctor will instruct you to begin taking medications after a cluster headache begins to help stop the attacks. Medications including a calcium channel blocker (verapamil) or a drug to treat bipolar disorder (lithium) often prevent or reduce cluster headache attacks. Your doctor also may recommend ergotamine, for short-term use, or several anti-seizure medications as preventive therapies. An inflammation-suppressing medication (corticosteroid) often effectively prevents cluster headache attacks, but it should be used for only a short time.

Surgery

Doctors rarely may recommend surgery for some people who have chronic cluster headaches who haven't had success with other treatments. Mayo Clinic surgeons will work with you to determine if you're a candidate for surgery.

• Trigeminal nerve procedure. Your surgeon may cut part of the nerve around and behind your eye (the trigeminal nerve) with a scalpel or make small burns to destroy part of the nerve. Surgeons often don't advise or perform this surgery, as it carries significant risks and complications.
• Occipital nerve procedure. For temporary relief of cluster headaches, doctors may inject an anesthetic in the area around your occipital nerve, at the back of your head, to block the nerve and prevent pain (nerve block).