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What Medicines Stop a Cluster Headache Emergency?

A person suffering a cluster headache emergency needs something that will work right away. Inhaling oxygen can help. One reader found Zomig worked.

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.

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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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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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