The information below is a short summary of my own findings about cluster headaches. I would like to stress that I am not a medical professional. For medical advice I urge you to consult your GP or neurologist. Brand names I use here are of treatments available in Belgium. This may vary depending on which country you are from.
Despite the causes of cluster headache are currently unknown, there is medication that can have a beneficiary effect on a lot of patients. These treatments are often used against other conditions, but have been proven effective for cluster headaches as well. The treatment of cluster headaches is twofold: there are effective prophylactic treatments and there are acute treatments. Prophylactic treatments are meant to keep the attack frequency as low as possible, while acute treatments are used to stop attacks when they occur.
Prophylactic cluster headache medication
In Belgium verapamil is sold under brand names Isoptine and Lodixal. This chemical is a calcium channel blocker and is mainly used to treat high blood pressure and cardiac arrhythmia. It has a relaxing effect on the muscles surrounding blood vessels. For most cluster headache patients verapamil is the preferred treatment. The ideal dose varies from patient to patient en can go up to 960mg per day, depending on how well the sufferer can tolerate the dose. It is important to get regular cardiograms when using verapamil because it lowers blood pressure and heart rate.
Topiramate is sold under the brand name Topamax in Belgium. This medicine is used for migraines and epilepsy. Some cluster headache sufferers are also treated effectively. There are however some rather annoying possible side effects like dizziness and fatigue.
Lithium’s main purpose is to treat manic depression and has a soothing effect. Research has shown that some cluster headache patients see a lowered attack frequency while being treated with lithium. Why this is the case is unknown. Long term use of lithium can have adverse effect on kidney functions and needs to be stopped when this occurs.
Couple of anti-epileptic treatments
Small studies with anti-epileptic medication have shown positive results at keeping cluster headache frequency in check, but these treatments are considered third grade in the battle against cluster headache because the changes of succes are rather small. Examples are valproate and gabapentin.
Acute cluster headache medication
Research has shown that breathing pure oxygen can abort a cluster headache attack. The dose to accomplish this is is 12 to 15 liter a minute. Why oxygen works is unknown, but that it works has been proven in double blind trials.
In Belgium sumatriptan is sold under the brand name Imitrex. To treat a cluster headache attack sumatriptan is injected under the skin to be able to work very quickly. Because attacks last for a relatively short period of time this is important to abort an extremely painful attack. After injecting sumatriptan the blood vessels in the body shrink and by doing so the pain disappears. It is quite a shock effect on the body, tingling fingertips, heavy arms and legs are side effects that are almost always present after injection. One injection contains 6mg of sumatriptan, but experimentation by some cluster headache patients has shown that 3mg and even 2mg are also effective. Important note is that you can only inject twice every 24 hours.
Generally speaking, painkillers have no effect on cluster headaches, but I mention them here because for me codeine in a high dose helps to take the edge of an attack. The attack is not aborted, but the pain level drops to an acceptable amount. Side effects are dizziness and fatigue.
Apart from these medications there are also some surgical procedures that are sometimes used to battle cluster headaches. In 2013 a neurostimulator was implanted in my head to abort attacks without resorting to medication. I will write extensively about my experience with this stimulator.
To conclude, I would like to stress the fact that every cluster headache patient is unique en there is absolutely no guarantee that certain medication will work for everybody. Up until now there is no specific treatment to get rid of cluster headaches.
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