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Medications

Medications used to treat cluster headache are grouped into 3 main areas:

Preventive medication - these are medications you may use on a daily basis to try to prevent your CH from occurring. Finding the right medications that are suitable, tolerable and effective for you can take some time, and the problem is that usually, you need to take such medications for a month before they start to work, and of course by then you cluster may be on it's way out anyway.

Abortive medication - these are medications that you use when you begin to feel your cluster headache attack begin, taken only on a "per-attack" basis. When taken at the beginning of a CH attack may stop a cluster headache before it reaches full intensity

Transitional Medication - Steroidal anti-inflammatory medications, usually containing Cortisone (Prenisone, Prednisolone, Dexamethasone etc) are often used as an acute intervention measure. Occasionally a local anesthetic called Lidocaine/Lignocaine infusion may be used as an acute transitional therapy, administered intravenously to inpatients in hospital.

 

You may find that you need to take a combination of medications to effectively manage your cluster headaches. Medication that may work quite well for one patient, may fail in another. What works for you in this cluster headache period may not work for you the next time you have another bout of cluster attacks.

Preventatives

Abortives

 

Some tips for your visit to the GP, specialist and Pharmacy:

Visiting your GP.

Go to your GP well prepared - and also make sure that they are well prepared. Print off as much information as you can from the sources on this site and take it with you to your GP or specialist appointment if you can. Make sure that you have also read the information you have found and have a general idea as to what your options are.

GP's and nursing staff in Accident & Emergency rooms are not trained to know everything about cluster headache so try not to blame them for lack of knowledge. Cluster headache is relatively rare and is most definitely a specialist area. Be polite but persistent with your GP, many GPs will sometimes not prescribe the correct medication on any number of grounds. If they suffered the same pain that you do they would prescribe what you needed in a heartbeat! Sometimes, if you feel like you are getting nowhere, you may have to seek a second opinion and find an alternative GP.

 

A trip to a Specialist may be required.

GPs may not know all the specialty areas in treating CH, nor should they as they are not Neurology specialists. Your GP may need to refer you to a Neurology specialist for further assessment, correct diagnosis, treatment and access to some medications.

The Australian Pharmaceutical Benefits Scheme (PBS) currently lists no medications approved for specific use in cluster headache. GPs themselves can only prescribe a few medications suitable for use in cluster headache and although they will do their best to help, they can have a hard time working within the constraints of our health system.

In some chronic and intractable cluster headache cases, specialist referral will certainly be required to obtain medications for "off-label", or "experimental use", or for use at higher than normal dosages. These medications are usually well understood and are routinely used in treating cluster headache.

Some medications fall within the specific area of Specialist or Neurologist care for treatment of cluster headache. A Specialist, or Neurologist can make arrangements to have medications effective in cluster headache prescribed for you. There may be a waiting list to see a Specialist or Neurologist.

Sometimes a GP will refer you to a Pain Management Unit (PMU), where a dedicated multi-disciplinary team of medical Specialists can work with you to find solutions to your Cluster Headache condition. Sometimes a PMU approach may help you avoid the need for medications in the first place, or even help to reduce your reliance on medications you may already use. A specialist PMU team can help arrange medication and many other treatment approaches appropriate for you where you may have other medical conditions, or medications to consider. Wait lists for PMU clinics can be at times, quite long, but access to this type of care can be well worth the wait.

 

Headache Diary

There is something you can do while you are working with your GP and waiting to see your Specialist or Pain Management Unit team; fill in your Headache Diary. For those new to cluster headache, or for those with existing headache conditions looking to clarify or review their diagnosis, printing off a headache diary and keeping records of your headaches is generally a good idea.

The only way a practitioner can correctly diagnose headache conditions is through taking a detailed oral patient history from you. What you tell them will form the basis of your diagnosis and access to the correct medication. Gathering as much data as you can on your headache condition is very helpful to all involved. A Headache diary also allows you to list any medication(s) or treatments you may already be using and how effective they are for you.

Taking a copy of your headache diary to your GP or Specialist will save both them and yourself much time in settling on the correct diagnosis and quickly accessing appropriate medication(s) for you. A Headache Diary can help you and your practitioner to increase your chances of becoming pain free much sooner..

Click here for a link to an excellent Headache Diary from NPS Medicinewise. The introduction explains why a headache diary is necessary for both you and practitioners and has full instructions on how to fill it in.

 

At the Pharmacy

When you have received your prescriptions, be sure your prescriptions allow you enough medication to avoid running short. If this is a problem ensure you ask for more medication when you need it - most doctors will make arrangements for repeat medication if you simply keep going back and be persistent.

Although sometimes difficult to get, "Regulation 24" Authority prescriptions enable GPs to offer a patient prescribed medications with all repeats dispensed by Pharmacy in one go, so you don't run short. Regulation 24 prescriptions are for people who cannot regularly make it to a Pharmacy, or are going away on holiday. Great for travelers.

 

Consumer Medical Information (CMI) sheets

When you do get your medication(s), ask your Pharmacist for a print off of your medication's CMI, or "Consumer Medical Information" sheet. Read these sheets carefully and thoroughly to make sure you have not been prescribed a medication that will conflict (a drug interaction) with a different medication that you may be taking.

Many drugs used to treat cluster headache are from the same drug groups. Be careful not to double up on the same drug type. Be sure to check the CMI sheet for a list of other drugs that should not be taken in combination with your newly prescribed medication.

 

Contraindications

In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain treatment.

Also check your CMI sheet to see that your medication is not contraindicated; that is when a drug is inappropriate for you to use. This may be because you may be allergic to it, or one of its ingredients, or you may have another medical condition in which your new medication prescribed for cluster headache, is inappropriate for you to take.

Your GP should assess you for any contraindications before prescribing any medication. If you have a known existing medical condition, known allergy, or feel that any medication may be inappropriate for you to use, please ask your GP, Specialist and Pharmacist about it. Asking questions about drug contraindications can save you from some nasty situations and may even save your life.

Be sure to ask your Pharmacist to check your medications at the time of collecting them. Most Pharmacies and GPs now have software that can pick up dangerous drug interactions and contraindications at point of sale, before you are left alone with a sore head to work it out for yourself.

Let your Pharmacist know what medications you already take, so they can assess your new medication for safety. This helps save many patients from an undesirable drug interaction or contraindication and possibly an unscheduled emergency hospital visit.

GPs, Specialists and Pharmacists are trained to pick up on contraindications and known drug interactions. Don't rely solely on the systems of GPs, specialists and Pharmacists to get it right! Mistakes can still happen, so be sure to check for safety and know about your new medication before taking it.

Medications can be a complex and tricky business to get right in Cluster Headache treatment, so don't ever be afraid to ask questions of your GP, specialist, or Pharmacist, no matter how trivial or silly the question may seem. It's what health care professionals are there for; to help you manage your condition, safely, effectively and to keep you well informed of what is going on at all times.

Feel free to post on the forum, ask any questions about medications. Whilst we are not Doctors and cannot provide medical advice; with many years of combined experience as CH patients site users are here to help and can provide names of GPs, practitioners, CMI sheets and if asked, can also offer the benefit of their own personal experiences with Medications they may have used in Cluster Headache.



It is strongly advised that you discuss any or all of this with your GP and/or Specialist and work together to create a good plan on how best to treat your headaches.

All medications mentioned above are medications prescribed by a health care professional. Health care professionals will discuss any medications and pre-existing medical conditions with you. When working with you, Practitioners will assess you for suitability of any medication and assess the risks and benefits of any medication(s) before prescribing any medication to you.

Remember; we are not Doctors, this information is provided for reference and/or information purposes only, as explained in the site disclaimer below. Always discuss any medication or treatments for Cluster headache with a qualified health care professional.

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