The pain of cluster headaches is so severe that they are often termed “suicide headaches.” They last from 15 minutes to several hours and can occur up to 8 times a day. Injectable sumatriptan is usually rapidly effective, but the cost becomes prohibitive when needed several times daily for weeks to months at a time. Further, the medication cannot be used in people with coronary artery disease or risk factors for this, as it may trigger a myocardial infarction in that group.
Vagal nerve stimulation, targeting a nerve on the side of the neck and requiring surgery, is used to treat intractable epilepsy. There is now a noninvasive vagal nerve stimulation device, which looks like a large ultrasound probe and is applied to the side of the neck. It led to a doubling of the percentage of sustained responders compared to a placebo group. This was defined as an improvement in headache at both 15 minutes and 1 hour after treatment. It seemed to work better for patients with “episodic” cluster, meaning that the period of headaches lasts for several months and then clears, as opposed to those with chronic headache, which means that patients have daily headaches for 1 year or more. More studies are planned.
Results were presented at the American Headache Society’s 2015 Annual Scientific Meeting (abstract LBP07).