Treatment of Cluster Headache

Cluster headache is a rare form of primary with excruciating type of pain (generally felt behind the eyeballs), which are non-fluctuating and explosive in nature and most important being the periodicity of the headache (typical cluster headache generally has a bout or two attacks of headache every day for 8-10 week per year).

The most important aspect of treatment of cluster headache is administration of drugs to prevent cluster attacks until the bout is over and it gives satisfactory result. But acute attacks of cluster headache are also required at some time or other for almost all patients with cluster headache.

The attacks of cluster headaches usually peaks very rapidly and faster acting drugs are required for treatment. Many patients with cluster headache gets very good result with oxygen inhalation. For this purpose 100% pure oxygen should be given to the patient with cluster headache for 15-20 minutes at the rate of 10-12 liters per minute (very high rate or dose). High flow and purity of oxygen is important in this regard.

Other treatment modalities of cluster headache includes subcutaneous (oral sumatriptan is not effective for prevention or for acute treatment of cluster headache) sumatriptan 6 mg, which is rapidly acting and can shorten the duration of acute attacks of cluster headache to 10-15 minutes. There is no evidence of development of tolerance or reduction in effectiveness of sumatriptan after prolonged use (very good advantage). Those who not wish to self-inject sumatriptan (subcutaneously) daily can use nasal spray of sumatriptan (20 mg) and zolmitriptan (5 mg), both of which are equally effect as that of subcutaneous injection of sumatriptan in case of acute attacks of cluster headaches.

Neuro-stimulation therapy: When medical therapies fail in chronic cluster headache, neurostimulation therapy can be tried. Deep-brain stimulation of the posterior hypothalamic gray matter has proven successful in a substantial proportion of patients for whom medical therapy has failed. Good results have also been reported with the less-invasive approach of occipital nerve stimulation.