Non-prescription drugs typically do not relieve cluster headaches. Therefore, treatment usually requires a prescription medication taken under a doctor's supervision.
Abortive therapy
The drugs of choice for cluster headache are oxygen and sumatriptan. These can either be given alone, or in combination. Inhaling pure oxygen may provide almost immediate relief for up to 80% of cluster headache attacks. Other initial treatment choices include prescription medications -- ergot derivatives or a triptan. For rapid relief of a cluster headache, an ergot derivative in a dosage form that is either quickly dissolved under the tongue (Ergomar), or injected (dihydroergotamine mesylate, DHE-45) is the second choice. Injected sumatriptan (Imitrex) may also be an effective treatment for cluster headaches in patients that don't respond well to oxygen and sumatriptan. Zolmitriptan (Zomig) may be considered over sumatriptan when given orally because 60% of patients experience relief at 30 minutes whereas sumatriptan may take longer to deliver relief.
Prophylactic/Preventive therapy
Calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan) and diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac), are also commonly used to prevent cluster headaches. Generally well tolerated, calcium channel blockers may cause constipation or swelling in the legs for some individuals who take them. Another well-tolerated medication is indomethacin, the only NSAID shown to be effective in preventing chronic cluster headaches. Possible side effects of indomethacin include dizziness, rash, stomach upset, and loss of appetite. The choice to begin taking indomethacin regularly should be carefully considered by a physician. Continued use of NSAIDs may lead to severe stomach irritation and result in ulcers (which must then be treated with more medications). Also patients with high blood pressure, heart failure, and kidney disease should know that taking NSAIDs may worsen these conditions. Always consult a physician before beginning long-term use of NSAIDs.
Other prescription medications that may be used to prevent cluster headaches may have more serious side effects, so they usually require close monitoring by a healthcare provider. Corticosteroids, such as prednisone (Deltasone, Orasone), may work well for preventing both episodic and chronic cluster headaches. They may cause insomnia, mood changes, upset stomach, and weight gain, however; and long-term therapy can affect thyroid function, cholesterol levels, blood pressure, and blood sugar levels.
Two other drugs used to treat cluster headaches are methysergide maleate (Sansert) and lithium (Eskalith, Lithobid). Methysergide maleate has been discontinued in the United States, but it may be available in other countries. Side effects from either methysergide maleate or lithium can be significant and treatment with either of them needs to be monitored closely by a healthcare provider.
