How to Prevent Cluster Headache

Prevention of cluster headache (and any other disease) is very important. Many drugs are available for prevention of cluster headache and the choice of drug/drugs for prevention depends on many factors like the length of bouts of cluster headache.

Patients with long bouts or patients with chronic cluster headache require medicines that are safe because they need to be taken for long periods. But for patients with relatively short bouts, limited courses of oral glucocorticoids (prednisolone) or methysergide (which is not available in the United States) can be very useful. A 10-day course of prednisone, starting with 60 mg per day for 7 days and followed by a rapid tapering, can interrupt the bout of cluster headache for many patients. Ergotamine at the dose of 1-2 mg is also very useful when given 1-2 hours before expected attack of bouts of cluster headache. But patients taking ergotamine need to be educated about the early symptoms of ergotism, like vomiting, numbness, tingling, pain, and cyanosis (blue color of skin due to lack of blood supply) of the limbs and a weekly limit of maximum 14 mg should be adhered to. Lithium (600–900 mg per day taken in 4 divided doses) is useful in chronic cluster headaches.

Many drugs are available for prevention or preventive treatment of cluster headache for short term prevention and for long term prevention. For short term prevention of episodic cluster headache, drugs are Prednisone (1 mg per kg and maximum of up to 60 mg 4 times a day, tapering over 21 days), verapamil (160–960 mg per day), methysergide (3–12 mg per day) etc.

For long term prevention of episodic cluster headache & prolonged chronic cluster headache, the drugs available are verapamil (160–960 mg per day), lithium (400–800 mg per day), methysergide (3–12 mg per day), melatonina (9–12 mg per day), gabapentin (1200–3600 mg per day) and Topiramate (100–400 mg per day). The last two drugs are not proven but of potential benefit in prevention of cluster headache.