Skip to main content

Cluster Headache: Preventative Treatment

  • Chapter
Pharmacological Management of Headaches

Part of the book series: Headache ((HEAD))

  • 1968 Accesses

Abstract

The main focus of management in cluster headache is to abort attacks when they occur and to prevent further attacks from happening within a bout. In the case of episodic cluster headache, this means that preventatives are taken only during the cluster bout. For chronic cluster headache, patients often have to be on long-term medication. Although a large numbers of agents are reported to be effective in the preventative treatment of cluster headache, this is usually on the basis of moderate-to-low quality evidence and open-label series. This chapter will review the medications used for the preventative treatment of cluster headache and also discuss the use of transitional treatments and neurostimulation in this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Headache Classification Committee of the International Headache S (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9):629–808

    Article  Google Scholar 

  2. Russell MB (2004) Epidemiology and genetics of cluster headache. Lancet Neurol 3(5):279–283

    Article  PubMed  Google Scholar 

  3. Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F et al (2005) Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 118(1–2):92–96

    Article  CAS  PubMed  Google Scholar 

  4. Afridi SK, Shields KG, Bhola R, Goadsby PJ (2006) Greater occipital nerve injection in primary headache syndromes–prolonged effects from a single injection. Pain 122(1–2):126–129

    Article  CAS  PubMed  Google Scholar 

  5. Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD (2002) Greater occipital nerve blockade for cluster headache. Cephalalgia 22(7):520–522

    Article  CAS  PubMed  Google Scholar 

  6. Lambru G, Abu Bakar N, Stahlhut L, McCulloch S, Miller S, Shanahan P et al (2014) Greater occipital nerve blocks in chronic cluster headache: a prospective open-label study. Eur J Neurol 21(2):338–343

    Article  CAS  PubMed  Google Scholar 

  7. Leroux E, Valade D, Taifas I, Vicaut E, Chagnon M, Roos C et al (2011) Suboccipital steroid injections for transitional treatment of patients with more than two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 10(10):891–897

    Article  CAS  PubMed  Google Scholar 

  8. Shields KG, Levy MJ, Goadsby PJ (2004) Alopecia and cutaneous atrophy after greater occipital nerve infiltration with corticosteroid. Neurology 63(11):2193–2194

    Article  CAS  PubMed  Google Scholar 

  9. Louis DS, Hankin FM, Eckenrode JF (1986) Cutaneous atrophy after corticosteroid injection. Am Fam Physician 33(1):183–186

    CAS  PubMed  Google Scholar 

  10. Jacobs MB (1986) Local subcutaneous atrophy after corticosteroid injection. Postgrad Med 80(4):159–160

    CAS  PubMed  Google Scholar 

  11. Jammes JL (1975) The treatment of cluster headaches with prednisone. Dis Nerv Syst 36(7):375–376

    CAS  PubMed  Google Scholar 

  12. Mather PJ, Silberstein SD, Schulman EA, Hopkins MM (1991) The treatment of cluster headache with repetitive intravenous dihydroergotamine. Headache 31(8):525–532

    Article  CAS  PubMed  Google Scholar 

  13. Magnoux E, Zlotnik G (2004) Outpatient intravenous dihydroergotamine for refractory cluster headache. Headache 44(3):249–255

    Article  CAS  PubMed  Google Scholar 

  14. Nagy AJ, Gandhi S, Bhola R, Goadsby PJ (2011) Intravenous dihydroergotamine for inpatient management of refractory primary headaches. Neurology 77(20):1827–1832

    Article  CAS  PubMed  Google Scholar 

  15. Lambru G, Shanahan P, Matharu M (2015) Exacerbation of SUNCT and SUNA syndromes during intravenous dihydroergotamine treatment: a case series. Cephalalgia doi:10.1177/0333102415570495

    Google Scholar 

  16. May A, Leone M, Afra J, Linde M, Sandor PS, Evers S et al (2006) EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol 13(10):1066–1077

    Article  CAS  PubMed  Google Scholar 

  17. Leone M, D’Amico D, Frediani F, Moschiano F, Grazzi L, Attanasio A et al (2000) Verapamil in the prophylaxis of episodic cluster headache: a double-blind study versus placebo. Neurology 54(6):1382–1385

    Article  CAS  PubMed  Google Scholar 

  18. Gabai IJ, Spierings EL (1989) Prophylactic treatment of cluster headache with verapamil. Headache 29(3):167–168

    Article  CAS  PubMed  Google Scholar 

  19. Jonsdottir M, Meyer JS, Rogers RL (1987) Efficacy, side effects and tolerance compared during headache treatment with three different calcium blockers. Headache 27(7):364–369

    Article  CAS  PubMed  Google Scholar 

  20. Bussone G, Leone M, Peccarisi C, Micieli G, Granella F, Magri M et al (1990) Double blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 30(7):411–417

    Article  CAS  PubMed  Google Scholar 

  21. Steiner TJ, Hering R, Couturier EG, Davies PT, Whitmarsh TE (1997) Double-blind placebo-controlled trial of lithium in episodic cluster headache. Cephalalgia 17(6):673–675

    Article  CAS  PubMed  Google Scholar 

  22. Ekbom K (1981) Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 21(4):132–139

    Article  CAS  PubMed  Google Scholar 

  23. Manzoni GC, Bono G, Lanfranchi M, Micieli G, Terzano MG, Nappi G (1983) Lithium carbonate in cluster headache: assessment of its short- and long-term therapeutic efficacy. Cephalalgia 3(2):109–114

    Article  CAS  PubMed  Google Scholar 

  24. Sicuteri F (1959) Prophylactic and therapeutic properties of 1-methyl-lysergic acid butanolamide in migraine. Int Arch Allergy Appl Immunol 15:300–307

    Article  CAS  PubMed  Google Scholar 

  25. Curran DA, Hinterberger H, Lance JW (1967) Methysergide. Res Clin Stud Headache 1:74–122

    CAS  Google Scholar 

  26. Kudrow L (1980) Cluster headache: mechanisms and management. Oxford University Press, Oxford/New York

    Google Scholar 

  27. Krabbe A (1989) Limited efficacy of methysergide in cluster headache. A clinical experience. Cephalalagia 9(Suppl 10):404–405

    Google Scholar 

  28. Graham JR, Suby HI, LeCompte PR, Sadowsky NL (1966) Fibrotic disorders associated with methysergide therapy for headache. N Engl J Med 274(7):359–368

    Article  CAS  PubMed  Google Scholar 

  29. Wheeler SD, Carrazana EJ (1999) Topiramate-treated cluster headache. Neurology 53(1):234–236

    Article  CAS  PubMed  Google Scholar 

  30. Forderreuther S, Mayer M, Straube A (2002) Treatment of cluster headache with topiramate: effects and side-effects in five patients. Cephalalgia 22(3):186–189

    Article  CAS  PubMed  Google Scholar 

  31. Hering R, Kuritzky A (1989) Sodium valproate in the treatment of cluster headache: an open clinical trial. Cephalalgia 9(3):195–198

    Article  CAS  PubMed  Google Scholar 

  32. Gallagher RM, Mueller LL, Freitag FG (2002) Divalproex sodium in the treatment of migraine and cluster headaches. J Am Osteopath Assoc 102(2):92–94

    PubMed  Google Scholar 

  33. El Amrani M, Massiou H, Bousser MG (2002) A negative trial of sodium valproate in cluster headache: methodological issues. Cephalalgia 22(3):205–208

    Article  PubMed  Google Scholar 

  34. Goadsby PJ (2002) Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 1(4):251–257

    Article  PubMed  Google Scholar 

  35. Leone M, D’Amico D, Moschiano F, Fraschini F, Bussone G (1996) Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 16(7):494–496

    Article  CAS  PubMed  Google Scholar 

  36. Pringsheim T, Magnoux E, Dobson CF, Hamel E, Aube M (2002) Melatonin as adjunctive therapy in the prophylaxis of cluster headache: a pilot study. Headache 42(8):787–792

    Article  PubMed  Google Scholar 

  37. Hering-Hanit R, Gadoth N (2001) The use of baclofen in cluster headache. Curr Pain Headache Rep 5(1):79–82

    Article  CAS  PubMed  Google Scholar 

  38. Leandri M, Luzzani M, Cruccu G et al (2001) Drug-resistant cluster headache responding to gabapentin: a pilot study. Cephalalagia 21:744–746

    Article  CAS  Google Scholar 

  39. Schuh-Hofer S, Israel H, Neeb L, Reuter U, Arnold G (2007) The use of gabapentin in chronic cluster headache patients refractory to first-line therapy. Eur J Neurol 14(6):694–696

    Article  CAS  PubMed  Google Scholar 

  40. Silberstein S, Goode-Sellers S, Twomey C, Saiers J, Ascher J (2013) Randomized, double-blind, placebo-controlled, phase II trial of gabapentin enacarbil for migraine prophylaxis. Cephalalgia 33(2):101–111

    Article  PubMed  Google Scholar 

  41. Tronvik E, Stovner LJ, Helde G, Sand T, Bovim G (2003) Prophylactic treatment of migraine with an angiotensin II receptor blocker: a randomized controlled trial. JAMA 289(1):65–69

    Article  CAS  PubMed  Google Scholar 

  42. Palermo A, Giglia G, Cosentino G, Raieli V, Brighina F, Fierro B (2013) Two cases of cluster headache effectively treated with levetiracetam. Funct Neurol 28(1):63–64

    PubMed Central  PubMed  Google Scholar 

  43. Mauskop A (2005) Vagus nerve stimulation relieves chronic refractory migraine and cluster headaches. Cephalalgia 25(2):82–86

    Article  CAS  PubMed  Google Scholar 

  44. Nesbitt AD, Marin JC, Tompkins E, Ruttledge MH, Goadsby PJ (2015) Initial use of a novel noninvasive vagus nerve stimulator for cluster headache treatment. Neurology 84(12):1249–1253

    Article  CAS  PubMed  Google Scholar 

  45. Goadsby PJ, Schoenen J, Ferrari MD, Silberstein SD, Dodick D (2006) Towards a definition of intractable headache for use in clinical practice and trials. Cephalalgia 26:1168–1170

    Article  CAS  PubMed  Google Scholar 

  46. Sharan A, Huh B, Narouze S, Trentman T, Mogilner A, Vaisman J et al (2014) Analysis of adverse events in the management of chronic migraine by peripheral nerve stimulation. Neuromodulation. doi:10.1111/ner.12243

    Google Scholar 

  47. Martelletti P, Jensen RH, Antal A, Arcioni R, Brighina F, de Tommaso M et al (2013) Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain 14(1):86

    Article  PubMed Central  PubMed  Google Scholar 

  48. Schoenen J, Jensen RH, Lanteri-Minet M, Lainez MJ, Gaul C, Goodman AM et al (2013) Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia 33:816–830

    Article  PubMed Central  PubMed  Google Scholar 

  49. Magis D, Schoenen J (2012) Advances and challenges in neurostimulation for headaches. Lancet Neurol 11(8):708–719

    Article  PubMed  Google Scholar 

  50. Schwedt TJ, Dodick DW, Trentman TL, Zimmerman RS (2006) Occipital nerve stimulation for chronic cluster headache and hemicrania continua: pain relief and persistence of autonomic features. Cephalalgia 26(8):1025–1027

    Article  CAS  PubMed  Google Scholar 

  51. Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J (2007) Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 6(4):314–321

    Article  PubMed  Google Scholar 

  52. Magis D, Gerardy PY, Remacle JM, Schoenen J (2011) Sustained effectiveness of occipital nerve stimulation in drug-resistant chronic cluster headache. Headache 51(8):1191–1201

    Article  PubMed  Google Scholar 

  53. Mueller OM, Gaul C, Katsarava Z, Diener HC, Sure U, Gasser T (2011) Occipital nerve stimulation for the treatment of chronic cluster headache – lessons learned from 18 months experience. Cen Eur Neurosurg 72(2):84–89

    Article  CAS  Google Scholar 

  54. Burns B, Watkins L, Goadsby PJ (2007) Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 369(9567):1099–1106

    Article  PubMed  Google Scholar 

  55. Burns B, Watkins L, Goadsby PJ (2009) Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients. Neurology 72(4):341–345

    Article  CAS  PubMed  Google Scholar 

  56. Leone M, Franzini A, Bussone G (2001) Stereotactic stimulation of posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 345:1428–1429

    Article  CAS  PubMed  Google Scholar 

  57. Bartsch T, Pinsker MO, Rasche D et al (2008) Hypothalamic deep brain stimulation for cluster headache: experience from a new multicase series. Cephalalgia 28:285–295

    Article  CAS  PubMed  Google Scholar 

  58. Fontaine D, Lazorthes Y, Mertens P, Blond S, Geraud G, Fabre N et al (2010) Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain 11(1):23–31

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Fontaine D, Christophe Sol J, Raoul S, Fabre N, Geraud G, Magne C et al (2011) Treatment of refractory chronic cluster headache by chronic occipital nerve stimulation. Cephalalgia 31(10):1101–1105

    Article  PubMed  Google Scholar 

  60. Franzini A, Ferroli P, Leone M, Broggi G (2003) Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52(5):1095–1099; discussion 9–101

    Article  PubMed  Google Scholar 

  61. Leone M, Franzini A, Broggi G, Cecchini AP, Bussone G (2012) Success, failure and putative mechanisms in hypothalamic stimulation for drug-resistant chronic cluster headache. Pain 154:89–94

    Article  PubMed  Google Scholar 

  62. Leone M, Proietti Cecchini A, Franzini A, Broggi G, Cortelli P, Montagna P et al (2008) Lessons from 8 years’ experience of hypothalamic stimulation in cluster headache. Cephalalgia 28(7):789–797; discussion 98

    Article  Google Scholar 

  63. Leone M, Franzini A, Proietti Cecchini A, Bussone G (2013) Success, failure, and putative mechanisms in hypothalamic stimulation for drug-resistant chronic cluster headache. Pain 154(1):89–94

    Article  PubMed  Google Scholar 

  64. Pinsker MO, Bartsch T, Falk D, Volkmann J, Herzog J, Steigerwald F et al (2008) Failure of deep brain stimulation of the posterior inferior hypothalamus in chronic cluster headache – report of two cases and review of the literature. Zentralbl Neurochir 69(2):76–79

    Article  CAS  PubMed  Google Scholar 

  65. Schoenen J, Di Clemente L, Vandenheede M, Fumal A, De Pasqua V, Mouchamps M et al (2005) Hypothalamic stimulation in chronic cluster headache: a pilot study of efficacy and mode of action. Brain 128(Pt 4):940–947

    Article  CAS  PubMed  Google Scholar 

  66. Starr PA, Barbaro NM, Raskin NH, Ostrem JL (2007) Chronic stimulation of the posterior hypothalamus region for cluster headache: technique and 1-year results in four patients. J Neurosurg 106:999–1005

    Article  PubMed  Google Scholar 

  67. Matharu MS, Zrinzo L (2010) Deep brain stimulation in cluster headache: hypothalamus or midbrain tegmentum? Curr Pain Headache Rep 14(2):151–159

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Manjit S. Matharu MBChB, FRCP, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Miller, S., Matharu, M.S. (2016). Cluster Headache: Preventative Treatment. In: Mitsikostas, D., Paemeleire, K. (eds) Pharmacological Management of Headaches. Headache. Springer, Cham. https://doi.org/10.1007/978-3-319-19911-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19911-5_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19910-8

  • Online ISBN: 978-3-319-19911-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics