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Treatment Options for Cluster Headaches
Drug Therapy
The levels of lithium in the blood must be monitored regularly to assess liver, renal, and thyroid function. Lithium is associated with several side effects including:
- Diarrhea
- Tremor
- Polyuria (increased production of urine)
- Dehydration
- Hyperthyroidism
- Renal dysfunction
Lithium is contraindicated for individuals taking certain drugs, including:
- Diclofenac
- Indomethacin
- Thiazides
- NSAIDs (nonsteroidal anti-inflammatory drugs)
Valproic Acid
Valproic acid is an anti-seizure drug that has shown efficacy in cluster headache patients in several small trials. It is effective in suppressing attacks in up to 70% of patients and relief is usually achieved within 1-4 days.
It is thought that valproic acid may be particularly helpful for individuals whose cluster headaches are accompanied by migraine-like symptoms (e.g., vomiting, photophobia, and phonophobia).
Adverse effects include:
- Nausea
- Weight gain
- Hair loss
- Lethargy
- Tremor
Topiramate
Topiramate is a newer anti-seizure drug that appears to be highly effective for chronic migraine and shows promise for patients with cluster headache. There have been several small studies showing that when topiramate is administered in fairly low doses, it may turn off cluster headaches within 1 to 2 weeks after starting the medication. In one of these studies, two of the patients on topiramate who achieved remission, suffered from chronic cluster headache. Active investigation of this drug continues.
Although topiramate is usually well tolerated, it can cause side effects so discussion with a physician will be necessary before starting this medication for cluster headache. It is contraindicated in patients with kidney stones. Some of the side effects may include:
- Somnolence (sleepiness)
- Ataxia (loss of coordination)
- Dizziness
- Kidney stones
- Some cognitive impairment
- Weight loss
Methysergide
Methysergide (Sansert) is an ergot alkaloid and is reported to be effective for prophylactic treatment of episodic cluster headache in 20-70% of patients, though data from rigorous clinical trials is not available. Like other ergot alkaloids, methysergide is not intended for long-term prophylaxis and is usually not prescribed for longer than 3-4 months.
Side effects may include:
- Nausea
- Muscle cramps
- Abdominal pain
- Pulmonary fibrosis (following long-term use)
Additional Prophylactic Drugs
There are several other drugs that may be used for prophylactic treatment of patients with cluster headache but which have undergone only limited scientific investigation, including:
- Lamotrigine
- Gabapentin
- Tizanadine
- Methylphenidate
- Baclofen (antispastic drug)
- Clonidine
- Somatostatin
A recent study of octreotide (a somatostatin analog) as an abortive treatment for acute cluster headache showed promising results. To read more about this study, click on the following link:
Pizotifen is commonly used in Europe but is not available in the United States. Studies performed on this drug are limited in number as well as in rigorous control but they indicate that improvement was noted in approximately 50% of participants with cluster headache. Pizotifen appears to be effective for patients with episodic as well as chronic cluster headache. Long-term affects are not well known.
Adverse effects of pizotifen may include:
- Drowsiness
