Cluster headaches are relieved by steroid injections in the back of the head, according to a study by French doctors, published in The Lancet. 43 patients with chronic and episodic cluster headaches were recruited into this blinded study where some patients received a steroid (cortisone) injection and some received saline water. The injections were given in the back of the head under the skull, on the side of headache. Injections were repeated every 2 – 3 days for a total of 3 injections. There was a significant improvement in patients who received cortisone. This study supports the wide use of a similar procedure, an occipital nerve block to relieve cluster headaches. In this study patients were allowed to take oxygen and sumatriptan (Imitrex) as needed. They were also started on verapamil for the prevention of cluster headaches and the injections were used for short-term relief while awaiting for the effect of verapamil to kick in. In my experience, some patients, especially those with episodic cluster headaches, may have complete resolution of their headaches just from the nerve block. Sometimes a single block is sufficient, but occasionally it helps for only a few days and needs to be repeated. It is likely that the injection technique and doctor’s experience can make a difference. Another option to stop cluster headaches is to take an oral steroid medication, such as prednisone, but taking it by mouth is more likely to cause side effects. Verapamil is an effective preventive drug, but it usually needs to be taken at a high dose – starting with 240 mg and going up to 480, 720 mg, and even higher. Verapamil is a blood pressure medication and before starting it and before increasing the dose an EKG is usually taken as it is contraindicated in people with some heart problems. In addition to verapamil, topiramate (Topamax), lithium, other drugs, and even possibly Botox injections can prevent attacks.
