Calcium channel blockers: The calcium channel blocking agent verapamil (Calan, Verelan, others) is often the first choice for preventing cluster headache. Verapamil may be used with other medications. Occasionally, longer term use is needed to manage chronic cluster headache.
Side effects may include constipation, nausea, fatigue, swelling of the ankles and low blood pressure.
Corticosteroids: Inflammation-suppressing drugs called corticosteroids, such as prednisone, are fast-acting preventive medications that may be effective for many people with cluster headaches.
Your doctor may prescribe corticosteroids if your cluster headache condition has started recently or if you have a pattern of brief cluster periods and long remissions.
Although corticosteroids might be a good option to use for several days, serious side effects such as diabetes, hypertension and cataracts make them inappropriate for long-term use.
Lithium carbonate: Lithium carbonate, which is used to treat bipolar disorder, may be effective in preventing chronic cluster headache if other medications haven't prevented cluster headaches.
Side effects include tremor, increased thirst and diarrhea. Your doctor can adjust the dosage to minimize side effects.
While you're taking this medication, your blood will be checked regularly for the development of more-serious side effects, such as kidney damage.
Nerve block: Injecting a numbing agent (anesthetic) and corticosteroid into the area around the occipital nerve, situated at the back of your head, might improve chronic cluster headaches.
An occipital nerve block may be useful for temporary relief until long-term preventive medications take effect.