What is the treatment for cluster headaches?

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Treatment is divided into treatments to relieve ('abort') each headache, and treatments aimed at preventing the headaches.

Treating each headache

Ordinary painkillers do not work. Generally, if you take an ordinary painkiller, it takes too long to work as the headache will usually have gone before the painkiller takes effect.

Sumatriptan given by injection just under the skin is the most widely used drug to 'abort' a headache. People with cluster headaches can be shown how to use this injection themselves. Use it as soon as a headache occurs. Sumatriptan is a 'triptan' medicine that is used to treat migraine and cluster headaches. It is not a painkiller. Triptans work by interfering with a brain chemical called 5HT. An alteration in this chemical is thought to be involved in migraine and cluster headaches. Some points about sumatriptan injection:

It works quickly (within 10 minutes or so) to ease the headache in most affected people.
The adult dose is a 6 mg injection for each headache. The maximum dose in 24 hours is two 6 mg injections (12 mg) with a minimum interval of one hour between the two doses.
Side-effects sometimes occur, but if they do are generally mild and do not last long. They include feeling sick, dizziness, tiredness, and dry mouth. A minority of people also develop a warm-hot sensation, tightness, tingling, flushing, and feelings of heaviness or pressure in the face, arms, legs, and occasionally the chest.
Some people should not take sumatriptan. For example, some people with heart disease, stroke disease, or peripheral vascular disease.

Sumatriptan by injection is usually the 'first-line' treatment. Other treatments that have sometimes been used include: sumatriptan nasal spray, breathing 100 percent oxygen, ergotamine injections, and lignocaine nasal spray. In general, these are often not as good as sumatriptan injections and are less commonly used.