Cluster headache: What helps?

Many people find that breathing pure oxygen during an attack relieves the pain. This involves using a face mask that is connected to an oxygen cylinder. You can control how much oxygen flows through the mask per minute using a regulator. Experts recommend at least 8 to 12 liters per minute. You sit upright, cover your nose and mouth with the mask, and breathe the oxygen for 15 to 20 minutes.

Oxygen therapy has few side effects and is well tolerated by most people. If you have chronic obstructive pulmonary disease ( COPD), talk to your doctor about whether this type of oxygen therapy is suitable for you.

Before starting oxygen therapy, most people will stay in a hospital for one or two days to find out whether – and at what dose – oxygen relieves their pain. After that, they can continue the treatment at home. There are portable units that you can use when traveling. In Germany, statutory health insurers pay for oxygen therapy after an application has been submitted.

Two medications for migraine attacks can also be used to relieve cluster headaches. These "triptan" medications are called sumatriptan and zolmitriptan.

When used for the treatment of cluster headaches, sumatriptan is injected just under your skin – using a pre-filled pen, for instance. You place it on the skin and then inject the medication by pressing a button. It is best to inject it as soon as the pain starts – for example, into your belly, upper arm or thigh. People often feel a noticeable improvement after only 10 to 15 minutes.

When zolmitriptan is used for cluster headaches, it is delivered in the form of a nasal spray. Here it's a good idea to spray the medication into the nostril on the pain-free side of the head.

An analysis of several studies showed that triptans don’t relieve cluster headaches when taken in the form of tablets. It might take too long for the effect of tablets to kick in – cluster headache attacks often already go away on their own by then.

Both of the triptans can relieve the pain. Studies that compared sumatriptan to a placebo (both injected at the beginning of the cluster headache) found the following: After 15 minutes, the symptoms had gone away completely in

• 15 out of 100 people who were given a placebo, and
• 42 out of 100 people who were given sumatriptan.

Zolmitriptan nasal spray is thought to be slightly less effective than sumatriptan here.

Both of the triptans can cause side effects like nausea and dizziness. They can also make your blood vessels narrower. Because of this, they’re not recommended for people with untreated high blood pressure or coronary artery disease.

It is not clear whether other treatments can relieve cluster headaches. Nasal sprays containing the local anesthetic lidocaine are sometimes used if, for instance, the headache attacks strike several times a day. Using a triptan injection or nasal spray for each attack would then result in an overdose and more side effects.

The vast majority of cluster headaches can be relieved with oxygen or medications. In the rare cases where they can’t, people may have a surgical procedure that aims to reduce the pain by stimulating certain nerves. There is currently a lack of research on the effectiveness and possible side effects of these procedures.