There is no standard formula for preventing cluster headaches. What may help one person, might not help another. What may help treat the episodic condition may not be helpful for managing the chronic condition. Treating Cluster Headache is done widely by way of trial and error.
Not unrelated, it is not uncommon for an individual to experience a temporary favorable response to a medication before it may become ineffective. Also, it is not uncommon for a medication to have helped at one point in time, but at another point in time, it does not. It can be speculated that with preventatives, especially the last drug prescribed during a cycle, the natural conclusion of a cycle may be mistaken for the presumed effectiveness of the medication. This may help to explain why a medication that seemed to have worked during one cycle does not work when taken during a future cycle.
The current Level A treatment recommendations by the American Headache Society for Cluster Headache for prophylactic (preventive) use only lists suboccipital steroid injections. What follows are some of the drugs commonly prescribed to prevent cluster headache:
- Verapamil (a calcium channel blocker formulated for treating high blood pressure)
- Methylprednisolone/Medrol (anti-inflammatory benefits)
- Topiramate/Topamax (anti-convulsant)
- Valproic Acid/Depakote (anti-convulsant, mood stabilizer)
- Frovatriptan/Frova (vasoconstrictor borrowed from migraine treatment)
- Indomethacin/Indocin (anti-inflammatory)
- Lithium Carbonate (mood stabilizer)
- Ergotamine Tartrate/Ergomar/Cafergot (vasoconstrictor borrowed from migraine treatment)
- Pizotifen (antihistamine and anti-serotonin agent)
- Greater Occipital Nerve Injection with Lidocaine
A once effective preventative medication for many with Cluster Headache was Methysergide/Sansert, though it was discontinued for use in 2013 in the U.S. It provided vasoconstriction and inhibited the production of serotonin. It is mentioned here, apart from the others, because it was synthesized from LSD, which is one of the alternative treatments that will be discussed in a following section.
In addition to prescribed medications, some who experience Cluster Headache may benefit from using Capsaicin Nasal Spray or taking supplements, such as kudzu and/or Melatonin (10mg/daily), both noted for having preventative qualities. Also, the Vitamin D3 (Anti-Inflammatory) Regimen has been reported as an effective preventative.
Apart from medications, there are several medical/surgical procedures available for those who do not respond to pharmaceutical interventions. These procedures often are measures of last resort. They include:
- Occipital Nerve Blocks
- Occipital Nerve Stimulation (ONS)
- Radiofrequency (RF) Thermocoagulation (Neurotomy) of the Trigeminal Ganglion
- Gamma Knife Radiosurgery
- Hypothalamic Deep Brain Stimulation (DBS) – produced negative study
Fast Statistics on Cluster Headache and Indoleamine Hallucinogens
- A 2006 study conducted at Harvard Medical School found remarkable results in CH patients and LSD or psilocybin mushrooms:
- Psilocybin reports:
- 22 of 26 patients said psilocybin aborted their attacks.
- 25 of 48 patients said cluster cycle was terminated.
- 18 of 19 patients said psilocybin extended their remission periods.
- LSD reports:
- 7 of 8 patients reported LSD terminated cluster cycle.
- 4 of 5 patients said LSD extended remission periods.
- Psilocybin reports:
- A 2017 qualitative thematic analysis of user accounts in forum discussions found:
- CH patients consider illegal psychoactive substances as a last resort.
- There is little to no interest in the psychoactive impact of these compounds.
- Patients choose sub-psychoactive doses to avoid or limit the “trip” effect.
- Patients reported prophylactic and acute treatment for cluster headache using psychedelic tryptamines: LSD and psilocybin mushrooms.