Drugs can treat cluster headaches

DEAR DOCTOR K: I get excruciatingly painful cluster headaches. What can I do to treat, or better yet, prevent them?

DEAR READER: Cluster headaches are rare. Only about one adult in a thousand suffers from them. But they are among the most painful of all headaches.

A typical cluster headache begins suddenly, often waking a person from sleep. The pain is intense, sharp and penetrating. It usually occurs behind one eye.

After an hour or two, the pain and other symptoms usually recede, sometimes as suddenly as they came on. But they tend to recur at the same time day after day.

Most people have episodic cluster headaches. They have one or two headaches a day over two to eight weeks, alternating with headache-free stretches that may last from a few weeks to several years. That’s why they’re called “cluster” headaches: They cluster during a window of time, then go away, then come back and cluster again.

Cluster headaches are often treated with a drug called sumatriptan (Imitrex). When given promptly by injection at the start of a headache, sumatriptan can relieve cluster headache attacks within 15 minutes.

Another effective treatment is inhaling pure oxygen. Oxygen can be administered in an emergency room or at home from a portable tank. An injection of dihydroergotamine (DHE-45) can quickly alleviate severe pain as well.

You should also talk to your doctor about medication to prevent cluster headaches. You’ll start taking the preventive drug when your headache first comes on, and you take the medication for as long your episodes generally last. Most doctors start with a sustained-release form of the calcium-channel blocker verapamil (Calan, others).

Another option is high doses of steroids such as prednisone, which can prevent further attacks within 24 to 48 hours. Once you’ve interrupted the pattern, your doctor can slowly reduce the dose to the minimum necessary to suppress your headaches. You’ll gradually taper the dose down to nothing.