The traditional treatment used to halt cluster headaches once a series
has begun is steroids. Typically prednisone at doses of up to 100 mg is
commonly
used. This therapy has many potential side effects so many physicians have
begun to use it as a second-line agent.
Perhaps the most common first-line agent for cluster prevention is verapamil
which comes under many brand names and many forms. When verapamil alone
is not effective, it is not uncommon to use depakote or lithium. Lithium
has more potential toxicity (particularly kidney) but depakote is associated
with more potential for weight gain.
When all of the above do not work, then Neurontin® or Topamax®
may be tried. This is based on their use in small nonblinded studies.
In addition, physicians have tried nasal lidocaine and nasal capsaicin
or a synthetic analog civamide. The lack of control data on all of these
less common remedies make it harder to evaluate their effectiveness.
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