man suffering cluster headache emergency

Cluster headaches are called that because they occur in “clusters” of repeated, excruciating headaches. They are often one-sided and may center behind one eye. The eye may tear and the nose may run. Sufferers may describe the pain as if a hot poker were being thrust into the head. These desperate individuals may bang their heads or rub them on the carpet in a futile attempt to ward off the pain. Victims who breathe pure oxygen for 15 minutes can often stop the headache, but they don’t always have oxygen available. If you have ever experienced cluster headaches, you’ll want to know how to stop a cluster headache emergency. 

Stopping a Cluster Headache Emergency:

Q. I have suffered from repeated cycles of cluster headaches. They’ve come every 3 to 5 years since the early 90s. Each cycle lasts 4 to 6 weeks with multiple headaches daily.

The neurologist I saw finally came up with a solution: prednisone and verapamil as preventive medicine and Zomig as an emergency measure. After I started on this regimen, I experienced a headache from eating too much chocolate. (I knew alcohol could trigger a cluster headache, but the chocolate was a surprise.)

Although I took one Zomig tablet without relief, I took a second one 45 minutes later and the headache was gone in seven minutes. Because this has worked so well for me, I have never needed to use the oxygen treatment.

Drugs for Cluster Headaches:

A. Cluster headaches are incredibly painful, and they can be difficult to treat. High-flow oxygen is a first-line therapy (Robbins et al, Headache, July, 2016). So are sumatriptan injections or zolmitriptan nasal spray (Zomig). Oral medicines aren’t expected to work fast enough to stop a cluster headache emergency.

Doctors may prescribe the blood pressure pill verapamil off label to prevent cluster headaches. Headache experts consider it one of the most effective medicines for warding these headaches off (Gooriah et al, Therapeutics and Clinical Risk Management, Nov. 9, 2015). However, people who use this medication regularly may experience constipation, low blood pressure or swelling of the feet and legs (Kingston & Dodick, Annals of Indian Academy of Neurology, April 2018). They should request a baseline cardiogram before starting and another each time the doctor increases the dose.

Learn More:

If you would like to learn more about oxygen or alternatives such as melatonin for cluster headache, you may wish to read our Guide to Headaches and Migraines. To order a print copy, please send please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. M-98, P. O. Box 52027, Durham, NC 27717-2027. You can also purchase a pdf for download.

You may be interested in some of our interviews with renowned headache experts. Dr. Jennifer Kriegler of the Cleveland Clinic discussed headache treatment, including cluster headaches, in Show 1133. We also interviewed her for Show 1055: What Are the Best Treatments for Headaches?  

What Triggers Cluster Headaches?

Unlike migraines, cluster headaches aren’t usually linked to triggers. However, you may not be the only one who reacts badly to alcohol or chocolate. Researchers have found that some people develop cluster headaches in response to alcohol (Panconesi, Journal of Neurosciences in Rural Practice, Apr-June 2016). In addition to chocolate, experts suggest avoiding MSG and aged meats or cheeses during the cluster cycle (Robbins, Practical Pain Management, April 30, 2018).

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  1. Jerry

    This sounds like the headaches that my wife had after eating Chinese food made with MSG. I would have to take her to Emergency. Fortunately, we found out that the culbrit was MSG. We avoided Chinese food until some restraunts quit using it in their food.

  2. Pecos
    Newport Beach CA

    Had clusters off on for 35 years. Best treatment lasted 3 years, then a month of misery. Latest, clear one year. My salvation has been daily dose of 1 10 mg melatonin and 1 500 mg magnesium. So far so good. During the last bout had success with 1 tab sumatran, And oxygen when bad.

  3. David

    I was a smoker for over 30 years and quit “cold turkey.” Very shortly thereafter I started getting cluster headaches. They lasted for about 6 months, and I have had none ever since, over thirty years. I attributed them to nicotine withdrawal.

  4. Alma
    Slaton, Texas

    My husband had these for years. The only thing that would help
    Was to use the zostric cream with the peppers in it. A doctor gave him some small sample tubes. (Suppose to be use for aches and pains). Told him to put a TINY bit, I mean TINY bit, up each side of his nose…..and it works……He used it every time he has a cluster headache and he hasn’t had them in years.. he’s 80 years old now.

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