Figure. DR. RICHARD LIPTON ADVISES
Q I've been experiencing cluster headaches for years. Is there anything I could do to prevent them?
A Cluster headaches derive their name from the fact that the headaches come in clusters. Attacks may occur several times a day for weeks or months, followed by long headache-free periods.
The duration of individual headaches tends to be short: 30 to 90 minutes. But they are agonizing. People have described them as feeling like a hot poker in the eye.
Severe one-sided pain is often associated with other features. These can include drooping of an eyelid, eye redness and tearing, and nasal stuffiness-all on the same side as the head pain.
Cluster headaches are almost always benign. But there are some serious conditions that can cause a similar pattern of headaches. Therefore, people with a new onset of cluster headaches should have an MRI.
As with migraines, treatment can be abortive or preventive. Because cluster headaches are relatively short-lived but intense, abortive therapies need to work quickly. One very effective acute treatment is oxygen, administered at home by face mask; it typically works within 10 minutes.
Another very effective therapy is injectable sumatriptan (Imitrex), which is also used for migraines. That works in about 5-10 minutes. There is also a nasal spray, which is not as fast as oxygen or sumatriptan injections.
The mainstay of treatment, though, is prevention.
Prednisone and other steroids work very quickly to turn off a cluster attack. But these are powerful drugs that shouldn't be taken on a long-term basis.
For the long term, a calcium channel blocker known as verapamil works very well-but it takes a couple of weeks to kick in. So, a new patient will be started on prednisone and verapamil simultaneously; then the prednisone can be tapered off.
Patients with cluster headaches should probably be managed by a neurologist, since most primary care physicians will see only one or two patients with this problem in their whole career.