Introduction

Ideally, you should be under the care of a healthcare provider experienced in managing this type of headache—such as a neurologist, a pain specialist, or a family doctor with specialized training in this field.

• You and your healthcare provider will collaborate to create a plan. This plan will help you distinguish which types of pain you can manage safely at home, which require contacting your healthcare provider, and which demand an immediate visit to the hospital's emergency department.
• It's essential to remember that these headaches can be excruciating, and your healthcare provider will always be there to assist you.
• If you experience a severe headache that differs from your usual ones, promptly inform your healthcare provider.
• Contact your healthcare provider if you encounter new side effects from the medications you are taking.
• If you've never had headaches before or haven't consulted a doctor for headaches and suddenly experience a severe headache, reach out to your healthcare provider or go to the hospital's emergency department.

Seek immediate medical attention or visit the hospital's emergency department under the following circumstances:

• When your current medication fails to control the pain, and you need immediate relief.
• When your pain prevents you from eating and drinking, putting you at significant risk of malnutrition or dehydration.
• When you experience severe side effects from your medications, such as extreme drowsiness, sedation, nausea, and vomiting.
• When a doctor advises you to seek evaluation and treatment for any of these issues.
• When there is a change in the severity or increased frequency of headaches, or when a headache feels different from any previous ones.

Self-Care at Home

You can manage cluster headaches at home under the guidance of a healthcare provider. Treatment typically involves two types of care, and many individuals require both simultaneously:

• Preventive treatment: This involves the ongoing use of medications proven effective in preventing or reducing the number of headaches, even when you're not currently experiencing one. Examples include beta-blockers (Inderal, Tenormin), anticonvulsants (Topamax, divalproex, carbamazepine), tricyclic antidepressants, and calcium channel blockers. Selective serotonin reuptake inhibitors (SSRIs) like Prozac, paroxetine, and escitalopram are generally ineffective for headaches.
• Abortive treatment: This is designed to stop a headache once it has started. Medications may include ergotamine (Bellamine, Cafergot), acetaminophen-isometheptene-dichloralphenazone (Midrin), dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray), and more recently, triptans like almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
• Furthermore, many medications used to treat migraine headaches (Excedrin Migraine Pain Reliever/Pain Reliever Aid, oxygen, prednisone) can also be effective for cluster headaches.

Outlook

• Cluster headaches can be persistent or episodic, with individuals transitioning between the two. Many people with cluster headaches can be pain-free for a year or longer, only to have the frustrating cycle of daily headaches return.
• As with migraines, individuals with cluster headaches respond to widely available and increasingly affordable treatments. With appropriate medical treatment and guidance, cluster headaches can be managed.