VIDEO
Acute Treatments for Cluster Headache and Paroxymal Hemicrania
Cluster headache is very different from migraine but, despite this, can respond well to triptans. The challenge with cluster headache is that each episode of pain can be very short-lived – so short-lived that no drug can work quickly enough to reduce the time the pain lasts. Only if the pain lasts for at least 30 minutes is it feasible to try a triptan, usually as a nasal spray or injection, to stop the pain once it has started.
I have tried lots of different painkillers to treat my cluster headache but none of them seems to work very well. Why is this?
Ordinary painkillers do not usually work well for cluster headache pain, mainly because they do not work quickly enough. An injection of something such as diclofenac may ease the pain, as it can start to work within 15 to 20 minutes of being used. Diclofenac suppositories can work almost as quickly if you can’t face the thought of using an injection. The advantage of the suppository is that you can administer it yourself, rather than needing a doctor or nurse to give you an injection.
My doctor has given me sumatriptan tablets but they don’t seem to help very much. Why is that?
That depends on what you mean by ‘very much’. Does it just ease the symptoms or does it have no effect at all? It may be that you need to increase the dose, from 50 mg to 100 mg, or you should swap to the injection or nasal spray, which will work more quickly and therefore help ‘a bit more’. Your doctor will not know it’s not helping unless you go back to tell him. There are other options, so do go back to find out about them.
My cluster headache lasts up to an hour. What’s the best thing to take for it?
The best would be the one that works quickly with the minimum of side effects. The quickest is likely to be an injection or nasal spray, but these may cause you unacceptable side effects. A tablet or wafer may cause fewer side effects but not work quite as quickly. Only you can decide which the best is.
My cluster headache usually lasts two to three hours. My doctor has given me sumatriptan tablets; do you think they will work?
They should work if you take them quickly enough, and 100 mg is likely to work better than 50 mg. It may be that they will only ease the headache rather than take it away completely.
My cluster headache only lasts 10 to 15 minutes. Is there anything I can take to help?
This is difficult because most treatments take this long to work. For cluster headache this short, oxygen tends to be the only option that has a chance of working quickly enough. Because acute treatment options are limited for such a short acute episode, you probably want to think about taking some preventative treatment. If you have episodic cluster, a short course of oral steroids is probably the best option for you, provided there are no reasons why you can’t take them.
My specialist has suggested that I try oxygen to treat my cluster headache. How do I go about getting a supply?
The very first time you need oxygen, a Home Oxygen Order Form (HOOF) in United Kingdom for example has to be completed. This can be done by your doctor or your specialist. The form is then sent to the contractor for your area or region, who will deliver the oxygen to your door. Your doctor or specialist will also need you to sign a consent form so that your information can be held on file by the contractor supplying your oxygen.
If I use oxygen, do I need a special regulator and mask?
You don’t need a special regulator, because the high-flow valve is an integral part of the oxygen cylinder and is supplied with it. To treat cluster headache effectively you need a flow rate of at least 9 liters per minute of 100% oxygen, and this information must be specified on the HOOF in the ‘short burst oxygen’ part of the form. The mask is special because you need one that has no holes in it. It will be supplied with your oxygen cylinder, provided it is listed on the HOOF.
My doctor has just faxed my HOOF to our local contractor. I am in the middle of my cluster episode – how quickly can I expect the oxygen to be delivered?
The contractors supplying oxygen provide a 24-hour service, seven days a week. A routine supply will be delivered within three working days. In an emergency, your cylinder can be delivered within four hours.
I have been using oxygen for the last few years for my cluster headache. I have always got my oxygen from my local pharmacist. I know the regulations have changed. How do I get more oxygen when I need it?
Once your local contractor has received a Home Oxygen Order Form (HOOF) all you need to do is phone them direct, and they will arrange delivery. The contractor does not need to have a HOOF every time you need more oxygen.
My doctor was trying to fill in my HOOF form and wanted to know how much oxygen I needed. How can I work it out?
In the past your doctor would simply stipulate on your prescription a certain number of cylinders. On the new form the number of hours per day is what is needed. You need to base your calculation on your worst day. The total number of attacks and how long you use your oxygen will give you the number of minutes or hours that you use the oxygen; the contractor will then decide how many cylinders to deliver to last you three days.
I use oxygen five or six times a day when my cluster headache is at its worst. How will I know when I need to reorder my oxygen?
When your first oxygen supply is delivered, the agent will be able to show you where on the cylinder you need to get to before ordering more. I have been told by the specialist that my headache is something called paroxysmal hemicrania. What is the best way to treat it?
Paroxysmal hemicrania is a unique headache in that treating it is easy. It responds well to a drug called indometacin. To control the symptoms of this type of headache, indometacin needs to be taken three times a day to a total daily dose of 150 mg.
