What are Cluster Headaches Treatments and Therapies?

Cluster headaches are diagnosed based on their distinctive pattern of episodes and pain. Your description of the attacks, including your pain, the location and intensity of your headaches, and any accompanying symptoms, can help the doctor diagnose.

Important variables include your headache frequency and duration.

Your doctor will likely use specific techniques to determine the nature and origin of your headache.

Neurological Testing

Your doctor may be able to find physical indicators of a neurological illness by doing a neurological examination. When a patient has cluster headaches, the exam is typically common exams and test. Your doctor will do several tests on your senses, reflexes, and nerves to evaluate how well your brain is functioning.

Image Exams

To rule out more dangerous causes of head pain, such as a tumor or an aneurysm, your doctor may advise further testing if you experience unusually severe or complex headaches or have an abnormal neurological examination. Typical brain imaging examinations include:

M.R.I. This creates precise pictures of your brain and blood arteries using a strong magnetic field and radio waves.

a C.T. scan produces detailed cross-sectional pictures of your brain using a succession of X-rays.

Treatment

  • Cluster headaches have no known treatment. Treatment aims to lessen pain intensity, minimize the duration of the headache, and stop episodes.
  • Cluster headaches can be challenging to diagnose and treat since they require fast-acting drugs, and their pain might come on unexpectedly and disappear quickly.
  • Acute medicine of various kinds can swiftly reduce some discomfort. The most successful treatments for cluster headaches, acute and preventative, are mentioned below.

Acute Therapies

  • Your doctor may prescribe quick-acting medications for:
  • Oxygen. For most people who use it, briefly breathing pure oxygen through a mask results in tremendous relief. Within 15 minutes, the effects of this low-cost, safe therapy become apparent.
  • In general, oxygen is risk-free and has no adverse effects. The main disadvantage of oxygen therapy is that you must always have an oxygen cylinder and regulator on hand, which can occasionally make the procedure difficult to access. Although small, portable units are available; some individuals still believe they are inefficient.
  • Triptans. Sumatriptan (Imitrex), a medication frequently used to treat migraines, is also a successful therapy for acute cluster headaches.
  • The initial shot could be administered while a doctor is monitoring you. Sumatriptan nasal spray may benefit some individuals, although it is often less effective than an injection and may take longer to take action. You shouldn’t use sumatriptan if you have heart disease or uncontrolled high blood pressure.
  • For the treatment of cluster headaches, zolmitriptan (Zomig), another triptan drug, can be used as a nasal spray. If you cannot handle other types of fast-acting medications, this drug can be a choice for you.
  • Because they sometimes take a while to work and are ineffective for treating cluster headaches acutely, oral medicines are.
  • Octreotide. Some persons with cluster headaches get relief from their symptoms with octreotide (Sandostatin), an injectable synthetic form of the brain hormone somatostatin. However, compared to triptans, it is less efficient overall and takes longer to function to reduce pain.
  • Regional Anesthetics. Some persons who get local anesthetics through the nose, such as lidocaine, may find relief from the agony of cluster headaches (intranasal).
  • Dihydroergotamine. For some cluster headache sufferers, dihydroergotamine (D.H.E. 45), an injectable version, maybe a potent painkiller. There is also an inhaled (intranasal) version of this medicine, but it hasn’t been shown to work well for cluster headaches.

Preventive Measures

To stop attacks, preventive treatment begins as soon as the cluster episode begins.

  • The length and frequency of your episodes influence which medication is best to take. Once the estimated duration of the cluster event has passed, you can taper off the medications with your doctor’s advice.
  • Blockers of calcium channels. The first line of defense against cluster headaches is frequently the calcium channel blocker verapamil (Calan S.R., Verelan). Verapamil can be used together with other drugs. Sometimes longer-term usage is required to treat a persistent cluster headache.
  • Possible side effects include constipation, weariness, ankle edema, and low blood pressure.
  • Corticosteroids. Fast-acting anti-inflammatory medicines known as corticosteroids, such as prednisone (Prednisone Intensol, Rayos), may be beneficial for many cluster headache sufferers.
  • If you have lately developed cluster headaches or a trend of short cluster episodes and lengthy remissions, your doctor may recommend corticosteroids.
  • Although corticosteroids could be a suitable alternative for a few days, they shouldn’t be used long-term due to major side effects, including diabetes, hypertension, and cataracts.
  • Carbonate of lithium. If previous drugs have failed to stop chronic cluster headaches, lithium carbonate (Lithobid), which is used to treat bipolar disorder, may be helpful.
  • Tremor, increased thirst, and diarrhea are symptoms. Your doctor can change the dose to reduce adverse effects.
  • Your blood will be monitored while you take this drug to watch for the emergence of more severe side effects, such as kidney damage.
  • Vagus nerve stimulation without pain (V.N.S.). Through the skin, the vagus nerve is stimulated using a handheld controller in vagus nerve stimulation (V.N.S.). Some studies revealed that V.N.S. helped decrease the frequency of cluster headaches, while additional research is required.
  • Block of nerves. Chronic cluster headaches may be lessened by receiving an anesthetic and corticosteroid injection into the region surrounding the occipital nerve, which is located near the back of your skull.
  • Until long-term preventative drugs start working, a temporary solution like an occipital nerve block may be helpful. It frequently works in tandem with verapamil.
  • Anti-seizure drugs, such as topiramate, are the additional preventative treatments for cluster headaches (Topamax, Qudexy XR).

Surgery

In rare cases, doctors may advise surgery for patients with chronic cluster headaches who do not respond to rigorous therapy or cannot handle the drugs’ adverse effects.

Surgery is required for sphenopalatine ganglion stimulation, which entails implanting a neurostimulator controlled by a handheld device. More studies are necessary; however, some suggested rapid pain relief and decreased headache frequency.

According to several modest studies, occipital nerve stimulation on one or both sides may be advantageous. To do this, an electrode is implanted close to either one or both occipital nerves.

The trigeminal nerve, which supplies the region behind and around your eye, is frequently targeted during some surgical treatments for cluster headaches to harm the neurological pathways considered responsible for pain.

However, there is debate over the long-term advantages of destructive techniques. Additionally, it’s not often thought of because of potential problems, such as jaw muscle weakening or sensory loss in particular parts of your face and head.

Future possible treatments

  1. Scientists are researching numerous possible therapies for cluster headaches.
  2. Activation of the occipital nerve. Your surgeon will perform this treatment by inserting electrodes into the back of your skull and connecting them to a tiny pacemaker-like device (generator). The electrodes stimulate the occipital nerve, which may block or lessen your pain sensations.
  3. According to several modest trials, occipital nerve stimulation was reported to lessen discomfort and headache frequency in certain sufferers with persistent cluster headaches.
  4. Brain-deep stimulation For cluster headaches that don’t respond to previous therapies, deep brain stimulation is promising but experimental therapy.
  5. An electrode is implanted during this surgery in the hypothalamus, the region of the brain responsible for timing cluster periods. Your surgeon connects the electrode to a generator, which modifies the electrical impulses coming from your brain and could help you feel better.

There are major dangers involved because it entails implanting an electrode deep into the brain, such as the possibility of infection or bleeding.

People with severe, persistent cluster headaches who have not found relief from medicine may benefit from deep brain stimulation of the hypothalamus.

Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084?p=1

How To Get Rid of a Headache: The 101 Guide – Icy Health. https://icyhealth.com/how-to-get-rid-of-a-headache-the-101-guide/

Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084?p=1