Cluster Headache Treatment Options
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No two people with cluster headaches take the same path to find relief. What works well for one person does nothing for another and what works today may not work overtime. Here's what we know about the cluster headache treatment options available, drawn from decades of experience working with thousands of patients to find the treatments that work best for them. You can use this to inform your conversation with your health care team.
Clusterbusters believes that alternative treatments can often be more effective than many pharmaceuticals. The latest information on alternative treatments is available atClusterHeadacheAltTreatments.org.
Key Takeaways
Cluster headache treatments fall into three categories: acute (abortive) treatments to stop an active attack, cycle-breaking treatments to end a cycle, and preventive treatments to stop a cycle from happening and/or reduce the frequency of attacks over time. Treatment plans that incorporate all three work best.
There is no one-size-fits-all approach. Treatment is largely trial and error, and what works for one person, or in one cycle, may not work in the next.
High-flow oxygen is the single most effective and reliable abortive for most people, and should be a first-line option.
Cluster Headache Treatment Options Overview
There is no single treatment that handles cluster headache, a comprehensive treatment plan rests on three pieces that work as a team. Treatments for cluster headache fall into three categories:
- Acute (Abortive) Treatments are used during an active attack to reduce its severity and duration.
- Cycle Breaking Treatments are used to bring a cycle of attacks to an end for those who are chronic and having especially frequent or intense attacks, to reduce the severity back down to baseline.
- Preventive Treatments reduce or eliminate cluster cycles and attacks over time.
See an example of a comprehensive treatment plan
Comprehensive Treatment Plan for Cluster Headache
There is no single treatment that handles cluster headache. A strong plan rests on three pieces that work together as a team: stopping attacks, breaking cycles, and preventing them over time.
Acute (Abortive)
Used during an active attack to reduce its severity and duration.
High-Flow Oxygen
Sumatriptan
These are common examples. Many more options exist in each category.
Cycle Breaking
Used to bring a cycle of attacks to an end.
Prednisone
In-Office Nerve Blocks
These are common examples. Many more options exist in each category.
Preventive
Taken over time to reduce or eliminate cluster cycles and attacks.
Verapamil
Emgality
These are common examples. Many more options exist in each category.
Learn more about options below and work with your doctor to build a plan that fits for you.
clusterbusters.org
We strongly recommend being seen by a neurologist with expertise in cluster headache. If you need one, we've compiled a list of national and international doctors who understand how to diagnose and treat cluster headache patients. Please discuss your treatment plan thoroughly with your healthcare provider.
A few important things to keep in mind
There is no one-size-fits-all approach. What works for one person may not work for another. What helps episodic cluster headache may do little for chronic cluster. Cluster headache treatment is largely trial and error. This can be frustrating, but finding the right mix can take time.
Almost all medications are prescribed off-label. With the exception of Emgality 300 mg and Brekiya, every medication used for cluster headache was originally developed for something else. Because the precise cause of cluster headache remains unknown, options have changed little over the past few decades.
Responses to medication can be unpredictable over time. It's not uncommon for a treatment to lose effectiveness, or for something that worked during one cycle to fail during the next. It's also important to remember, that unless you are chronic, your cycles of attacks will end naturally at some point. When a cycle stop happens near a medication change, it can be easy to credit the drug when the cycle was simply running its course.
Practical advice from Bob Wold Founder, Clusterbusters Read Bob's take Close
After years of helping people in the cluster headache community, Bob has seen a few patterns that can make the difference between a plan that works and one that doesn't.
Everyone responds differently
“One reason we are all different is that everyone's baseline chemical makeup and how our bodies react, is greatly affected by how long people have been on cluster medications and to what degree. The medicines we take, change how our bodies operate."
Be ready before a cycle starts
“Over time, clusterheads build a toolkit of medicines and strategies across these three treatment types so they are ready at any stage. The last thing you want to need when a cycle starts is to see your doctor and be told the next available appointment is in a month or two.”
Take an honest look at your plan
“One pattern that happens often in the cluster headache community is that if a medication isn't working well enough, a new one gets added without removing anything already in the plan. This is how people end up on 6 or 7 medications. If a medication treats your clusters and gives you 80% relief and there are only a couple of minimal side effects, then it’s easy to determine whether or not you want to continue on that drug regimen. But if you are on two or three or more medications and getting less than great results, it’s more difficult to make these risk/reward decisions. If you find yourself in that situation, it's worth stepping back and looking honestly at the total picture: What relief are you actually getting? What are the cumulative side effects costing you? Once your thoughts on this are clear, you should discuss with your doctor.”
— Bob Wold, Executive Director
Acute (Abortive) Cluster Headache Treatments
Acute (Abortive) Treatments are used during an active attack to reduce the severity and duration of the headache.
High-Flow Oxygen
For the majority of people with cluster headache, high-flow oxygen inhaled at the onset of an attack is the single most effective and consistently reliable abortive treatment available. It cannot be overstated how important oxygen is as a first-line option. Visit our oxygen page to learn everything you need to know about using 100% oxygen to abort attacks. Many people give up on oxygen because they were using it wrong or have the wrong equipment, and thus not seeing positive results.
Triptans
Sumatriptan (Imitrex, Sumavel DosePro)
A self-injectable vasoconstrictor borrowed from migraine treatment, sumatriptan is widely used and works quickly for those who respond to it. However, with continued use over time the drug can cause increased frequency of attacks and elevated pain levels during attacks. This rebound effect can lead to over-use of the drug, which essentially renders it counter-therapeutic. Many patients ask for sumatriptan vials instead of auto-injectors as some respond to just 2-3mg instead of the full 6mg, which cuts down on rebound attacks and medication-overuse.
DHE — Dihydroergotamine (IV, needle injection, nasal spray, Brekiya autoinjector)
One advantage DHE has over triptans is that it tends to provide longer-lasting relief. A single dose may give up to 24 hours of relief for some people, unlike sumatriptan which may only cover one attack. It's available as a vial injection, nasal spray (Migranal), and now as a ready-to-use autoinjector (Brekiya). IV DHE administered in a hospital setting over several days is also used to try to break a particularly brutal or prolonged cycle.
Brekiya
In October 2025, Amneal launched a ready-to-use dihydroergotamine (DHE) autoinjector approved for the acute treatment of cluster headaches. People living with cluster headache have long used DHE in various forms (infusions at hospitals or previous injectables / nasal sprays) with success. Brekiya enables easier at-home treatment using the same medication people with cluster headache have historically largely received in hospital settings. This is still relatively new and we are in early stages of hearing from patients who have tried it about the efficacy.
Other commonly prescribed acute treatments:
- Zolmitriptan / Zomig (vasoconstrictor nasal spray, borrowed from migraine treatment)
- Oral Zolmitriptan (vasoconstrictor, borrowed from migraine treatment)
These can be helpful and is used by some as part of their toolbox. Vasoconstrictors were used and studied a lot and for a long time. Clusters were thought to be vascular in nature more than neurological in nature. - Ergotamine Tartrate / Ergomar (vasoconstrictor, taken sublingually, borrowed from migraine treatment)
Ergots have always been a treatment for headache disorders and for many years these were the best treatment available. Ergots are the basis for many treatments for many different ailments. Nature provides. Those used for headache disorders can have some serious side effects in the long term. - Sphenopalatine Ganglion Block (SPGB) — View the technique for SPG block. These are becoming more and more an option that can provide relief for longer stretches of time. Locate a cluster specialist that knows what they are doing.
- Lidocaine (intranasal local anesthetic) — View Instructions on Lidocaine Use for Cluster Headache.
You need a prescription for this but it is relatively inexpensive. For cluster headache you need a 4% solution, applied with an eyedropper. The technique matters enormously as it must be done correctly or it won't work. Lidocaine sprays do not work. Do not bother with those. - Toradol (injectable anti-inflammatory)
This is sometimes helpful but it’s never enough to reduce suffering enough on its own. - Ketamine (sedative; IV or nasal spray) — Learn more about ketamine and cluster headache.
Ketamine is worth knowing about, but requires the right doctor. Most ketamine clinics are trained for mental health applications, not headache disorders, and the treatment plans are very different. Nasal ketamine compounded through a pharmacy can be a useful second or third-line abortive for individual attacks, and some patients notice a reduction in attack frequency with regular use. Tolerance develops quickly, so it is important to take regular breaks from it. IV ketamine administered in a hospital setting is a more intensive option sometimes considered for people stuck in a very bad or prolonged cycle. It is a Schedule 3 controlled substance and does not require a special DEA license to prescribe, though not all doctors will be familiar with its use for cluster headache.
Over-the-counter options:
- Capsaicin and Civamide — both derived from chili peppers — are available as intranasal products and used as abortives by some.
- Energy drinks containing caffeine or taurine have also been reported to provide relief during attacks. A cup of coffee or a Coke is likely not strong enough to abort an attack. Taurine seems to work even better than large doses of caffeine. Taurine is often the key active ingredient in energy drinks that help with cluster attacks. Look for drinks with the highest taurine content. These drinks can sometimes abort attacks, if used quickly enough. These tauring drinks also work well to treat “shadows.” Don't overuse these drinks - but having one on hand is a smart habit.
Cycle Breaking Treatments
Cycle Breaking Treatments are used to bring a cycle of attacks to an end, at least temporarily. Many times they can provide a much needed break from cluster headache cycles. between attacks. They can sometimes work long enough for the cycle to end. They can sometimes end a cycle early.
- In Patient DHE infusions. This is usually a 4-5 day hospital stay and can stop attacks for the duration of the stay. Attacks often return after a couple of days of getting home.
- Short Steroid bursts. An at home treatment and usually involves a prescription of Prednisone. High dose reaching up to 80mg a day. Then titrating down slowly. If you are on high dose for too long, you’ll need to consult with your doctor about getting an ACTH treatment to get your pituitary gland working again.
- In Office Nerve Blocks. These often work very well and there are different blocks used. Again, consult with your doctor. Find an experienced cluster headache specialist.
- In-Patient Ketamine. This is discussed in the section above under acute treatments, read our full guide on Ketamine.
Preventive Treatments
Preventive treatments reduce or eliminate cluster cycles and attacks over time.
Since American Headache Society's (AHS) guidelines for Cluster Headache were published in 2016, two notable treatment options have received FDA clearance or approval.
- Emgality In June 2019, Eli Lilly and Company made history by becoming the first company to receive FDA approval for marketing a drug for the treatment of episodic cluster headache. Emgality 300 mg has proven effective for many people with episodic cluster headache. It’s important to note that Emgality for cluster headaches is a different prescription than Emgality for migraine.Before each injection we recommend icing the injection site for 5 minutes to numb the skin. Clean the area with an alcohol swab, allow it to dry completely, and then administer the medication slowly. This will reduce the discomfort.
Learn more about Emgality. - gammaCore Sapphire In 2017, the FDA cleared gammaCore the first non-invasive vagus nerve stimulator (nVNS) for acute treatment of episodic cluster headache pain. It was subsequently cleared as a preventive treatment as well. It provides electrical stimuli to the vagus nerve in the neck, which can result in pain reduction, elimination, and for some, a decrease in the number of weekly attacks. Learn more about gammaCore.
Other commonly prescribed preventives:
- Verapamil (a calcium channel blocker originally formulated for treating high blood pressure)
This is the most commonly prescribed preventive and often the most effective. Doses vary widely, some people find relief at 120mg per day while others require up to 1200mg. Higher doses typically mean more side effects. If you have low blood pressure you’ll either have to avoid this one or be very careful. Constipation is one of the most common and persistent issues with long-term use, so plan for that. More importantly, verapamil can cause serious heart complications so regular EKGs are essential. If your doctor isn't ordering them, ask for them or ask to be switched to something else. - Steroids / Prednisone
Typically used as a short-term transitional treatment to cool off a cycle while preventives build up to a therapeutic level. The doses used for cluster headache are very high, usually starting at 60–80mg, and side effects at those doses can be significant, including mood changes and increased appetite. Long-term or repeated use carries serious risks including joint damage. Never stop prednisone cold turkey; the dose must be tapered down gradually. If you have been on high doses for an extended period, ask your doctor about ACTH stimulation testing to check your adrenal function before stopping. - Methylprednisolone / Medrol (anti-inflammatory)
One of the alternative steroids. There are several that get prescribed. The Medrol Dose Pack is convenient but often shorter term treatment than best use of this medication class. Important Note: If you have been on a steroid such as Medrol or Prednisone, ask your doctor about getting an ACTH shot to reactivate your body to start producing its own version of anti-inflammatory chemicals. The Pineal gland will shut down if it's not needed because of artificial measures such as steroids. Your doc may want to run a test to see if this shot is needed. If you don't ask, it may not come up - Topamax / Topiramate (anti-convulsant)
Often prescribed, but rarely successful at a dose low enough to maintain a normal quality of life. It has earned the nickname "Dopamax" in the community for good reason. Start at a low dose and titrate up slowly. - Valproic Acid / Depakote (anti-convulsant, mood stabilizer)
Rarely prescribed these days. There are also other anti-convulsants that can be prescribed but their use is less common these days because they are not usually very effective and used in tandem with other medication cocktails. - Lithium Carbonate (mood stabilizer)
Largely ineffective for episodic cluster headache but has helped some people with chronic cluster. Dosages are fairly high and side effects can be substantial, though they sometimes level off over time. It is a powerful drug, approach it carefully and with close medical supervision. If you are on lithium and considering alternative treatments, discuss this with your doctor first as the combination of these may produce seizure-like episodes. If people are taking lithium for bipolar affective disorder, they probably should continue taking lithium, and they should avoid taking tryptamines for cluster headaches. - Frovatriptan / Frova (vasoconstrictor, borrowed from migraine treatment)
One of the handful of triptan alternatives. Some work better than others for different people.. Some can work for longer periods of time or have fewer side effects than others. - Ergotamine Tartrate / Ergomar / Cafergot (vasoconstrictor, borrowed from migraine treatment)
Ergotamines have been used for clusters for decades but have been fazed out over time as treatments with fewer side effects have become available. - Indomethacin / Indocin (anti-inflammatory)
Used more as a diagnostic tool than an effective treatment plan. Your doctor may be trying to eliminate some headache disorders from your diagnosis. If it works, it will work very well and very quickly, if you don’t have cluster headaches. - Pizotifen (antihistamine and anti-serotonin agent)
Antihistamines have long been used by people, either through prescription or OTC. People begin using them often before getting diagnoses with clusters when they think it may be allergies or sinus infections. They do sometimes provide relief. Histamine has been considered a trigger for clusters for many years. - Greater Occipital Nerve Injection
Nerve blocks that may be offered may contain steroids but not all do. These can possibly help if done properly and are usually most effective when used in conjunction with other therapies. The blocks will wear off. Specialists are getting better at these blocks as time goes on. Find one that has experience blocking for clusters.
Other treatments that were not found to be effective:
- Eptinezumab was clinically tested and reported upon in 2025: The clinical trial was stopped early because it was not meeting minimal endpoints of effectiveness.
- Valproic Acid / Depakote (anti-convulsant, mood stabilizer)
Rarely prescribed these days. There are also other anti-convulsants that can be prescribed but their use is less common these days because they are not usually very effective and used in tandem with other medication cocktails.
Frequently Asked Questions
If a medication stopped working, can it work again later?
Sometimes. It's not uncommon for a treatment to lose effectiveness during one cycle and regain it during a future one. It's also worth knowing that all cycles for those who are episodic eventually end on their own, so a drug that appeared to "stop" a cycle may not have been the reason.
Why isn't there a standard treatment that works for everyone?
The precise cause of cluster headache still isn't fully understood, which leads to a frustrating trial and error approach for most people.
Are there differences in treating episodic and chronic cluster headaches?
Episodic cluster headache comes in cycles with periods of remission in between. Chronic CH has no meaningful remission period. This distinction matters because some treatments that help episodic patients have limited effect on chronic and vice versa.
How long should I wait to determine that a medication is not effective?
You should consult with your doctor, but generally speaking it may take a few weeks to months to evaluate whether a treatment is working.
You’re not out of options
If these treatments haven't worked for you, there are more paths to explore.