What is the preventive treatment for cluster headaches?

The preventive treatment for cluster headaches is verapamil. Cluster headaches, characterized by severe unilateral pain, are often treated with acute interventions during an attack, but management typically focuses on prevention for those with frequent or chronic episodes.

Verapamil is a calcium channel blocker that has proven efficacy in preventing cluster headaches. It helps by stabilizing calcium levels, which in turn decreases the excitability of vascular smooth muscle and, subsequently, reduces headache frequency and severity. Its use is supported by numerous studies indicating its effectiveness in lowering the likelihood of cluster headache attacks.

Other medications mentioned, such as amitriptyline and ergomar, are not first-line treatments for cluster headaches. Amitriptyline is more commonly used for migraines and is effective in treating chronic tension-type headaches but lacks the necessary efficacy for cluster headache prevention. Ergomar, which contains ergotamine, is primarily used for acute migraine attacks rather than for prevention of cluster headaches. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can provide symptom relief but is also not effective for prevention, as it does not address the underlying pathophysiological mechanisms associated with cluster headache attacks.

Therefore, verapamil stands out as the best choice for effectively preventing cluster headaches.