Headache disorders are managed primarily in two ways—acute treatments targeting the individual headache attack and preventive treatments that reduce the overall frequency and severity of the attacks.
For the acute treatment of cluster headache, the gold standard is high-flow oxygen. This involves breathing oxygen in through a non-rebreather mask (a medical device to assist in oxygen delivery) at 10 to 15 liters per minute.
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“High-flow oxygen can be effective in about 75% of patients with cluster headache and can be used at home, though there are several barriers to accessing this important treatment,” says Dr. Schindler. “Sometimes, clinicians aren’t aware of the treatment or don’t know how to order it, and then patients are not instructed on where to obtain the oxygen or how to properly use it.”
Insurance coverage for home oxygen is not uniform, and some patients are unable to have the treatment covered, even after providing scientific literature and letters from their doctors to the company, she adds.
If any headache disorder affects your ability to function on a daily or near-daily basis… you should consider making an appointment with a neurologist.
Emmanuelle Schindler, MD, PhD, a Yale Medicine neurologist
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Other options for acute treatment include triptan medications—sumatriptan (brand name Imitrex®) and zolmitriptan (brand name Zomig®), which are also used to treat migraine. “For cluster headache, triptans must be administered via nasal spray or injection just under the skin to get into the body very quickly,” says Dr. Schindler. “Oral pills take too long to get into the bloodstream—about as long as the cluster attack will last on its own.”
Anti-inflammatory medications, such as ibuprofen, are not effective in treating cluster headache, particularly when administered orally, she adds. “Narcotics should also not be prescribed for cluster headache or any other headache disorder as they are not effective and serve to generate more attacks,” she says. “Unfortunately, cluster headache patients are sometimes still prescribed narcotics, and they can become addicted to them.”
Preventive treatments for cluster headache include verapamil (brand name Verelan®), a medication also used to lower blood pressure, and galcanezumab (brand name Emgality®). Other treatments that can shorten a cluster cycle or induce a period of remission in chronic cluster headache include steroids, such as prednisone, and injections of dihydroergotamine (DHE), a medication also used to treat migraine.
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