Prophylactic Drug Treatment
The two main goals of preventive treatment for cluster are:
- To rapidly suppress individual attacks
- Maintain that remission throughout the patient’s typical cluster period.
Verapamil is the gold standard in the treatment of Cluster Headache. Treatment can be initiated at 120 mg daily and titrated up to 480 mg a day. Side effects are rare, but constipation is common. Other side effects include dizziness, nausea, edema, bradycardia, fatigue, and hypotension.
Prednisone (60mg a day) and Dexamethasone (4-8mg a day) are fast acting transitional prophylactic drugs that are used (usually in specialist centres) for Cluster headache prophylaxis.
Side effects include insomnia, restlessness, hyponatremia, edema, hyperglycemia, osteoporosis, myopathy, and gastric ulcers. The use of corticosteroids is discouraged in the long term in patients with chronic cluster headaches because the incidence of side effects increases with prolonged use.
Sometimes used in specialist centres, Lithium carbonate has been shown to be effective against episodic and chronic cluster headaches. Of cluster headache patients, 78% of patients with chronic clusters and 63% of patients with episodic clusters respond to lithium. The usual daily dose ranges from 600 to 900 mg in divided doses. Side effects might include tremor, polyuria, and diarrhea. Nephrotoxicity and hypothyroidism can occur with long-term use.