Preventive treatment of cluster headaches can be a great boon for the cluster headache sufferer because of the severe intensity of pain he/she suffers.
There are several medicines available for preventing cluster headache and you should leave it to your doctor to choose them, but these prophylactic medicines benefit you by lowering the frequency and duration, and in many cases preventing cluster headaches episodes.
These preventive medicines for cluster headaches are used every day until the anticipated period of the cluster headache ends and then are tapered off where necessary.
Cluster headaches do not onset due to any trigger factors as explained in cluster headache causes and triggers. However no medicine completely prevents a cluster headache.
Certain lifestyle improvements such avoiding smoking and alcohol, getting regular exercise and proper sleep, avoiding stressful situations and certain foods like aged cheese, eggs, chocolates and processed meats will help even otherwise .
Do keep a cluster diary which will help identify the time of the day and season of the year when you most likely get these headaches and their duration. Using preventive therapy at these times will help.
Drugs to prevent cluster headaches
The following drugs are used in the prevention of cluster headaches and have proved helpful.
Calcium channel blockers
Verapamil, a calcium channel blocking agent is the first line of treatment to prevent cluster headache. It is required to be used on a long-term basis and helps to reduce the frequency of the cluster headaches. It helps in the prevention of both episodic and chronic form of cluster headache.
Lithium carbonate has been found to be useful in preventing chronic cluster headaches by its action on the biological clock which is believed by experts to be linked to cause these headaches.
Side effects include excessive urination, tremors, and diarrhea. Minimum dosages are advised as this drug can cause kidney damage. The drug is stopped by tapering the doses to avoid side effects.
Corticosteroids such as prednisolone and methylprednisolone are used short-term because of their fast action.
They are particularly advised if the cluster headaches are of recent onset or if the cyclical pattern is of short cluster periods followed by long remission periods.
Long-term use of steroids is not advised because of their potential side effects such as glaucoma, cataract, high blood pressure, diabetes, GERD, obesity, osteoporosis and more.
Anticonvulsants or antiseizure drugs such as topiramate and valproic acid may be tried when other medications have failed.
Patients who take these drugs should be regularly watched and talked to as they can cause suicidal tendencies more so with the already existence of cluster (suicide) headaches.
Methysergide is an ergot alkaloid, which is taken for the prevention of cluster headache rather than treating it.
It acts by constricting the blood vessels and should be taken for the short cluster period only because of its potential side effects of causing thickening of the heart valves and of the lining of lungs and abdomen.
Starting with this drug and stopping it should be only on your doctor’s advice because it has to be stopped over tapering doses.
Melatonin in doses of 10 mg is seen to reduce the frequency of the cluster headaches thereby helping prevention of cluster headache periods.
Surgery for cluster headaches
Rarely, surgery is advised when the patients cannot tolerate the headaches and medicines have failed to give relief.
This surgery involves deadening the pain-sensitive cells of the trigeminal nerve (5th cranial nerve), which also innervates the area behind and around the eye. This helps in the prevention of cluster headaches.