The current Level A treatment recommendations by the American Headache Society(AHS) for Cluster Headache for prophylactic (preventive) use only lists suboccipital steroid injections.
Since AHS published these recommendations in 2016, several important advancements have been made.
On April 18, 2017, the FDA cleared gammaCore, the first nVNS stimulation therapy for the acute treatment of pain associated with eCH in adult patients. A year later it was cleared by the FDA as a preventive treatment. For more information about gammaCore, click here.
On June 6, 2019 Eli Lilly and Company made history by becoming the first pharmaceutical company to receive FDA approval for marketing a drug for the treatment of episodic cluster headache. Emgality 300 mg has proven to be effective for many people with CH. For more information about Emgality 300 mg, click here. It is important to note that Emgality for CH is a different prescription than Emgality for migraine.
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
There is no standard formula for preventing cluster headaches. What may help one person, might not help another. What may help treat episodic cluster headache may not be helpful for managing chronic cluster. 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. Sometimes a cycle naturally concludes and the patient or prescribing physician mistakes the last drug prescribed to be responsible for the conclusion of the cycle. 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.
With the exception of Emgality 300 mg, all other medications prescribed for Cluster Headache are done so off-label, meaning they were developed for other conditions but have been determined to have some efficacy for treating cluster headache. Because the precise etiology of Cluster Headache remains unknown, over the last few decades, little has changed within the complement of commonly prescribed medications and the associated diagnostic conditions from which they are borrowed.