Treatment. Cluster headache

Cluster headaches are periodic headaches that are characterized by severe painfulness. The condition is rare, but it can still cause extreme discomfort for the sufferer. Luckily, some treatments help prevent attacks or deal with headaches when they occur.

Cluster headaches diagnosis

The pain and pattern of cluster headache attacks are distinctive for this condition. The doctor suggests a diagnostics method according to the patient’s description of onsets. The last includes location, frequency and intensity of headaches, pain characteristics, and accompanying symptoms. The duration of headaches also plays a role.

Diagnostics methods may involve:

• Neurological examination. This method helps determine neurological disorders by physical symptoms. It is a usual procedure for patients with cluster headaches. The examination may involve testing the person’s reflexes, senses, and nerves to evaluate brain function. 
• Imaging tests. In the case of unusual neurological examination results, the doctor may suggest imaging tests like MRI or CT scan. In addition, the healthcare provider recommends these tests when the patient suffers from complicated headaches. This method helps exclude diagnoses like aneurysms or tumors.

Cluster headaches treatment

Unfortunately, there is no known way to cure cluster headaches. Nevertheless, available treatment aims to reduce pain intensity and duration. In addition, it helps prevent or decrease the number of attacks.
Cluster headache starts suddenly and develops rapidly. Additionally, it disappears as abruptly as it begins. Therefore, evaluation and treatment of this condition may be challenging because cluster headache requires medications that act quickly. It is helpful to consider therapeutic methods as two groups – acute and preventive treatment.

Acute cluster headache medications

The doctor can suggest the following options of fast-acting treatment to deal with cluster headaches:

• Oxygen. This method involves a brief inhalation of pure oxygen by a patient through a mask. It is an effective, safe and not expensive procedure. Moreover, most of the sufferers noted sufficient pain relief that can be felt within 15 minutes. A disadvantage of oxygen usage is having to carry around an oxygen cylinder and regulator. However, small portable oxygen units are available today. 
• Octreotide. It is a synthetic alternative to the somatostatin hormone produced in the brain. This cluster headache medication is injectable. Some people find it helpful for pain relief. Still, there are more effective treatment options available. 
• Triptans. This option may include the use of sumatriptan or zolmitriptan. One can take them in the form of injection, nasal spray or oral medications. It is worth mentioning that oral medicines are relatively slow-acting and usually don’t help treat acute cluster headaches.
  • Injections of sumatriptan are used to deal with migraines. In addition, they are help treat acute cluster headaches. The person may get the first injection while under medical observation. Sumatriptan can be beneficial in the form of nasal spray. Still, injections are generally more effective. Notable, this medication for cluster headaches isn’t suggested for people who suffer from heart disease or uncontrolled high blood pressure.
  • Zolmitriptan comes in the form of nasal spray. This cluster headache medicine can be beneficial for those who cannot tolerate other types of fast-acting medications.
• Local anesthetics. Intranasal administration of local anesthetics may provide pain relief for some individuals. This type of medication acts through its numbing effect to deal with cluster headache symptoms. 
• Dihydroergotamine. It is available in the form of injection or nasal spray and helps relieve the pain. However, there is no proof of the effectiveness of the nasal spray form of this drug.

Preventive treatment

The patient should apply the preventive treatment at the beginning of the cluster period to prevent the attack. The doctor prescribes specific medicines according to the regularity and duration of cluster episodes. Once the expected length of the cluster period has passed, you can stop taking the drugs. However, it is better to do so under the control of your healthcare provider. Preventive treatment may involve:

• Calcium channel blockers. This option is helpful to prevent the pain and, when used long-term, manage chronic cluster headaches. However, there are some side effects. The last can include fatigue, nausea, constipation, low blood pressure, and swelling of the ankles. 
• Lithium carbonate. In case when other options are not effective, this medicine may help manage chronic cluster headaches. However, side effects may involve diarrhea, tremor, and elevated thirst. Notably, during the treatment, the patient’s blood is regularly checked for the development of more severe side effects. One of them is kidney damage. 
• Corticosteroids. It is an anti-inflammatory fast-acting preventive medication that is effective for many cluster headache sufferers. The doctor usually recommends this option if the condition developed recently or the patient has a pattern of short cluster headache and long remission periods. However, such treatment can be used only for several days due the side effects of long-term use. They may include diabetes, cataracts or hypertension.
• Nerve block. An occipital nerve block is a temporal pain-relieving option taking until long-term medications start their effect. 
• Noninvasive vagus nerve stimulation (VNS). It is a delivery of electrical stimulation to the vagus nerve through the skin by a hand-held controller. Some studies determined that this procedure helps decrease the frequency of cluster headaches. However, additional researches are needed. 
• Anti-seizure medications.

Surgery

Although rarely, the doctor may suggest surgery to manage chronic cluster headaches. It is true when aggressive treatment doesn’t relieve pain or if the patient cannot tolerate medications or associated side effects. Options include:

• Sphenopalatine ganglion stimulation. It is the implantation of a neurostimulator operated by a hand-held controller. Although more research is needed, some studies identified fast pain relief and decreased frequency of headaches. 
• Occipital nerve stimulation. It is the implantation of an electrode near either one or both occipital nerves. 
• Procedures to damage the nerve pathways that are thought to be responsible for pain. The long-term effect is arguable. Moreover, there are some possible complications such as jaw muscle weakness or the loss of sensory function in certain parts of the face and head. Therefore, this procedure is rarely considered. 

Potential future treatment

There are researches focused on potential treatment options for cluster headaches, including:

• deep brain stimulation
• occipital nerve stimulation