Preventive Treatment for Headache: Cluster, Migraine, Tension Headaches

Preventing Attacks of Cluster Headache

Attacks are usually short, lasting from 15 – 180 minutes, and the excruciating pain may have subsided by the time a patient reaches a doctor’s office or emergency room. Because it can be difficult to treat attacks when they occur, treatment efforts focus on the prevention of attacks during cluster cycles.[1] Although certain drugs are standard, preventive therapy needs to be individually tailored for each patient. The doctor may prescribe a combination of drugs.

Verapamil (Calan), a calcium-channel blocker drug, is the mainstay preventive treatment for cluster headaches. However, it can take 2 to 3 weeks for this drug to take effect. During this period, corticosteroids (typically prednisone) may be used as an initial transitional therapy. For long-term treatment of chronic cluster headaches, lithium may be used as an alternative to verapamil.[2]

Although they are not approved for cluster headache, anti-seizure drugs such as valproate (Depakote), topiramate (Topamax), and gabapentin (Neurontin), are sometimes used for preventive treatment.

Headache Preventive Treatment

Preventing Attacks of Migraine Headache

Several medications are used for prevention of migraine.

  • Beta Blockers – Inderol and Toprol, which relax blood vessels.
  • Calcium channel blockers – Cardizem and Procardia, vasodilator and relaxes blood vessels causing migraine headache.
  • Tricyclic antidepressants – Amitriptyline.
  • Anticonvulsants – Depakote and Topamax.[3]

Preventing Attacks of Tension Headache

Avoid anxiety, fatigue, and hypoglycemia which triggers tension headache. Preventive medications used in tension headaches are:

  • Tricyclic antidepressants – Amitriptyline.
  • Anticonvulsants – Depakote and Topamax.
  • NSAIDs – Advil and Aleve.[4]


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