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Treatment Options and Choices for Cluster Headache Patients

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    In this section, information about medications, drugs, and treatments will be covered by category of intervention, namely preventatives, abortives, and alternatives. What follows first are brief summaries of some relatively standard traditional treatments. Countless prescription and over-the-counter medications have been recommended and tried for the treatment of Cluster Headache; the summaries are not intended to be comprehensive.

    A focus of greater elaboration will be on alternative treatments, as it is the position of Clusterbusters that these methods can be more effective at preventing and aborting Cluster Headache attacks than many pharmaceuticals, so we aim to provide accurate information on those substances and treatments. However, we strongly recommend you discuss your treatment plans fully and carefully with your health provider.

    The Correct Diagnosis

    First and foremost, before any treatment strategies are employed, a correct diagnosis is essential. It is important to be seen by a neurologist with expertise in diagnosing and treating cluster headache. We have compiled a list of national and international doctors who understand how to diagnose and treat Cluster Headache patients.

    A 2014 study found that it takes an average of 5.3-6.4 years from the onset of cluster headaches to an accurate CH diagnosis. That time frame is longer for women, particularly women of color. Patients are often misdiagnosed with migraine, “sinus headache” or sinusitis, and trigeminal neuralgia and go through an array of doctors including dentists and ENT specialists before getting a referral to a neurologist or headache specialist.

    Both physicians and those diagnosed with Cluster Headache will attest to the challenges of finding effective treatment/s for the disorder. The same 2014 study found that 88 percent of patients responded to medical treatment but hadn’t been given abortive or preventive options before or following their Cluster Headache diagnosis.

    In part, those challenges have been related to an ongoing absence of any FDA-approved prescription medications developed and marketed specifically for treating cluster headaches. On June 6, 2019, that changed. With the introduction of Emgality, Eli Lilly made history by becoming the first pharmaceutical company to receive FDA approval for marketing a drug for the treatment of episodic cluster headache.

    For more information about Emgality, click here.

    With the exception of Emgality, 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.

    Clusterbusters has split treatment information into three pages for easy navigation:

    These off-label medications are intended to prevent a cycle from occurring or used transitionally to prevent attacks from emerging after a cycle has begun, essentially breaking a cycle, or to abort attacks as they occur. However, some of them may be prescribed to serve multiple purposes. Typically, individuals are prescribed a combination of several preventative and abortive medications, with adjustments made ongoing, depending on degree of relief.

    It is important to note that many of the medications prescribed to treat Cluster Headache have unwelcome side effects, some of them irreversible and damaging. Following are summaries of commonly used preventative and abortive medications and treatments. For greater elaboration, clicking on the links below is recommended;

    For information about any drug you are taking or thinking about taking, please consider referring to the National Institutes of Health (NIH) or the U.S. Food and Drug Administration (FDA).

    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.
    • 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.
    in Treatment Options