What are cluster headache treatment options?

So, the treatment options for cluster headaches can be divided into three main groups. Those three groups are acute treatments, or painkillers, preventive treatments, treatments that you use to reduce the number of headaches that you have, and what we call transitional treatments or bridging treatments. Preventive treatments can often take a few weeks, occasionally even months to work, but patients who are in excruciating pain all understand if they want something that works very quickly for them. And transitional treatments are treatments that work quickly but don't necessarily work for very long. So, they're used as a bridge while you're waiting for your preventive treatments to work. In terms of acute treatments, there are two main treatments that are available. There are a group of drugs, designer-made drugs, called Triptans, which you can take as an injection or as a nasal spray. You can also use high-flow oxygen, but it has to be used at 100% at more than 7 litres per minute. But both of those treatments are highly effective. In terms of prevention, there are a whole host of drugs that can be used. A commonly used drug is one called Verapamil. Other examples are the drug called Lithium, another one called Topiramate, and Gabapentin. There are also exciting developments in that there are electrical stimulators that can be used. There is a stimulator called Vagal nerve stimulator that can be applied over the neck, that is proving to be quite effective to use. As I just pointed out, the issue with some of these treatments is that they do take a little while to work and because of that, we use what are called transitional treatments. And these transitional treatments often work very quickly but not for very long. Examples of transitional treatments include giving a course of steroids, you know, or doing something called a nerve block. You can mix a small dose of steroid and local anaesthetic and inject it at the back of the head, and it can be quite effective in at least two-thirds of people. In patients who fail to respond to all of these treatments, there are procedures that can be offered, invasive procedures. And some of the procedures that are done at Queen Square include Occipital Nerve Stimulation which involves putting electrodes at the back of the head with a battery on the chest and having electrical stimulation. You have a very similar concept with something called Deep Brain Stimulation where the electrode is put into this part of the brain called the hypothalamus which we think generates these attacks, and you have a battery that is on the chest and you have electrical stimulation going on in this part of the brain called the hypothalamus. And we have recently shown that that's quite an effective way of treating the cluster headaches. And finally, there is a new development of something called Sphenopalatine ganglion stimulation where you insert a stimulator in your cheek and you switch it on and off when you have a cluster attack and again, that is proving to be quite an effective treatment.