There are a number of treatment options available for cluster headaches. Although cluster headaches cannot be cured, treatments aim to relieve symptoms, shorten the headache period and prevent future episodes.

Although they do not cure cluster headaches, prescription and over-the-counter medications may also be used to prevent headaches, stop the progression of headaches and relieve symptoms.

Pure oxygen may be recommended as a treatment method for cluster headaches, particularly those that occur at night. Administered through a breathing mask, supplemental oxygen can provide pain relief within 15 minutes. However, this type of treatment may be inconvenient, because patients must carry an oxygen cylinder and regulator with them.

A combination of headache medications may be used to treat cluster headaches and to prevent future headaches. Treating an existing headache is called acute or abortive therapy.  These medications include antimigraine medications, which include:

• Triptans, which are a type of serotonin agonist. They may be injected or taken orally or nasally. These medications may not be prescribed for patients with certain conditions, including high blood pressure, angina and some liver conditions.
  
  
• Ergotamine or ergotamine derivatives. Drugs that constrict dilated blood vessels, which often occur with headaches. This medication may be used to prevent headaches as well, but side effects can be severe (e.g., nausea, confusion, vision changes) and is often not used for more than two or three weeks. These drugs may be used with others, such as isometheptene, which reduces throbbing pain.

Other forms of medication used for acute pain relief include local anesthetics. Acute medications should be taken as soon as the attack begins. They are effective in treating the rapidly peaking pain associated with cluster headaches because they are fast-acting.

Over-the-counter drugs such as aspirin and ibuprofen are not effective in treating cluster headaches because they take too long to take effect. In most cases, the headache has disappeared by the time these medications begin to work.

There are also a number of medications used to reduce the frequency and severity of cluster headaches and increase the effectiveness of acute medications. These preventive drugs are used in short-term and long-term management strategies. Short-term drugs are fast-acting but can cause serious or undesirable side effects. The long-term medications take longer to work but can be used safely for a longer period. These medications are often taken together at the beginning of a cluster period. Patients typically discontinue the short-term medication after a couple of weeks but continue taking the long-term drug.

Short-term medications include:

• Corticosteroids. Commonly used to relieve inflammation, these drugs may be prescribed to treat cluster headaches that have recently developed. They may also be recommended for patients with brief cluster periods and long remissions. Because of the side effects and risks associated with long-term use, such as osteoporosis and diabetes, these drugs are usually taken for only a few days.
  
  
• Nerve block. An anesthetic may be injected into the fibers surrounding the occipital nerve (a nerve located at the back of the head) to prevent pain messages from traveling to the trigeminal nerve and the pain-sensitive structures in the head.  

Long-term medications include:

• Calcium channel blockers. These antihypertensives increase the flow of oxygen-rich blood to the heart, lower blood pressure and reduce the workload of the heart. They may be used from the development of a cluster period until three to four weeks following the last headache. In some cases the medication may be used for a longer period of time to treat chronic cluster headache.
  
  
• Lithium. A drug that acts on the central nervous system and is commonly used to treat bipolar disorder (manic-depressive illness), lithium is also prescribed to prevent chronic cluster headache.

Additional preventive medications include:

• Beta blockers. These antihypertensives decrease the workload of the heart and lower blood pressure.
  
  
• Tricyclic antidepressants. These drugs are commonly used to treat depression but also can help relieve some pain conditions. Antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents. As a result, people being treated with these drugs should be closely monitored for unusual changes in behavior, according to the U.S. Food and Drug Administration (FDA).
  
  
• Antihistamines. These drugs are commonly used to treat allergic reactions and prevent an increase in release of histamines. However, these drugs are not usually effective in treating a cluster headache once an attack begins.
  
  
• Indomethacin. This nonsteroidal anti-Inflammatory drug (NSAID) is commonly prescribed to relieve pain, tenderness, inflammation and stiffness.

Medications used to treat cluster headaches have variable effectiveness in different people. In many cases, a number of medications may be tried before an effective drug, or combination of drugs, is found.

Though men are far more likely than women to have cluster headaches, they may be undertreated. A recently completed nine-year British study involving more than 400,000 patients found that women are more likely to seek medical help for headaches and to receive prescriptions. Anyone suffering from cluster headaches or other headaches is advised to take the initiative in seeking help. 

In addition to taking medications, patients may reduce the frequency of cluster headaches by avoiding factors that trigger the headaches. Patients may identify these triggers by keeping a headache diary for two months or longer. To compile this journal, patients record certain information after each headache occurs, including:

• When the headache occurred
• How severe the headache was
• Where the headache was located
• How long the headache lasts
• Medications taken prior to and after the headache
• Events before the headache (e.g., consumption of alcohol)
• Sleep patterns and amount of sleep

In general, there are a number of steps a patient can take to avoid a cluster headache, including:

• Avoiding alcohol because it often triggers attacks during a cluster period
• Avoiding cigarettes and other tobacco products
• Maintaining a regular sleep schedule
• Avoiding afternoon naps
• Avoiding certain medications if possible (e.g., nitroglycerin)
• Avoiding glare and bright lights

In rare instances, surgery may be recommended for treatment of chronic cluster headaches. Patients who do not respond to medication and those who cannot tolerate the side effects of medication may benefit from this form of treatment. However, surgery might be an option only for patients who experience pain on one side of their head. Because the surgery can be performed only once, patients experiencing pain on alternating sides of the head risk that the procedure will be ineffective.

A number of surgeries may be used to treat the trigeminal neuralgia that may be associated with cluster headaches (cluster-tic syndrome):

• Conventional surgery (trigeminal nerve section).  A surgeon uses a scalpel to sever part of the trigeminal nerve (the nerve in the head believed to be responsible for pain), or uses tiny burns to destroy a section of the nerve. Conventional surgery provides relief for the majority of people who undergo the procedure.
  
  
• Radiosurgery. A surgeon uses a focused beam of radiation to destroy a section of the trigeminal nerve. Although this form a surgery is noninvasive and linked with fewer side effects, the safety and permanency of the procedure have not been established.