Triptans, alcohol and smoking

The cause of cluster headaches is not yet fully understood. However, certain trigger factors for cluster headaches are known: stopping smoking, on the other hand, is seen as a particularly important factor in preventing episodes on the one hand and in preventing the transition from the acute to the chronic form on the other. Triptans are administered intranasally or subcutaneously in the form of “sumatriptan” for cluster headaches.

Subcutaneously, the drug works reliably after only a few minutes and shows no loss of efficacy even after long-term use. When taken nasally, the effect is slowed down. To prevent further seizures, a targeted, coordinated drug therapy is advisable.

Alcohol
The stay in high altitudes
Histamine
Nitroglycerin

Inhalation of 100% oxygen for acute treatment

Inhalation of pure oxygen has proven to be very helpful in acute headache attacks. The gas can be absorbed gently and effectively via a face mask. Over a period of 15 minutes a quantity of approx.

7L oxygen per minute is inhaled. Afterwards, the symptoms should have reduced significantly. There is a change in the blood flow in intracerebral vessels (vessels in the brain).

There are no side effects of this application and it can be especially helpful in case of accompanying symptoms (like running nose). A disadvantage is the somewhat impractical application. The face mask and oxygen bottle are difficult to transport.

Furthermore there is no prophylactic effect.Taking 100% oxygen is helpful to end an acute headache attack, but does not prevent a new attack. It is therefore a symptomatic therapy. Nevertheless, it is a very gentle and helpful form of therapy.

Interval therapy

There are so-called episode-free intervals between headache clusters in the acute form of cluster headache. Within these intervals, prophylactic therapy is given to prevent the occurrence of new clusters. Drugs that are suitable for prolonged use include: These drugs can be taken in addition to the acute phase drugs.

An exact dosage and adjustment of the medication is carried out by the treating physician.

Ergotamine
Verapamil
Lithium
Triptans

Ergotamine tartrate is a vascular stimulant with relatively few side effects. The drug can be taken over a long period of time and is said to have a success rate of up to 70%.

Triptans, which are used in acute therapy, can also be used in different doses for interval treatment. Verapamil is a calcium antagonist (heart medication) and is well tolerated in long-term use. Lithium (psychotropic drug) has a similar effect on cluster headaches, but is usually not as well tolerated as verapamil.

Both drugs only show a significant improvement in symptoms after a certain period of use (approx. one week), which is why corticosteroids are also frequently taken as a short-term supplement. An individually tailored and adapted medication should be adjusted by the treating physician. From the large number of medications, a selection should be made which is most effective for the individual patient (e.g. in young women who wish to have children, choose medication accordingly). The aim is to prevent the recurrence of cluster headaches by taking the most effective medication.