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Reader’s Mail: Medication and Time May Both Help Migraine and Cluster Headache

Q. I have been reading NHF’s HeadWise for a few years now and find it very informative and helpful. I wish I didn’t need the information, but I have been diagnosed with cluster migraine. True to pattern, I can go two to three years without a migraine, except for two to three migraine attacks per month occurring prior to my period. The clusters occur two to three times a day for a few months then remit for a couple of years. After every cluster, I always hope it will be my last time.

Are they ever going to stop? Does a person outgrow them? I am currently taking amitriptyline daily, Imitrex® as needed and have just started Topamax® as a preventive when a cycle strikes.

A. It sounds like you have both migraine and cluster headaches. Cluster attacks occur 1 to 5 times a day and are short but severe attacks of pain, usually around one eye. A cluster of attacks will last 1 to 3 months. Cluster headache attacks usually become farther apart as one grows older, but not always. Migraine also tends to be less severe and less frequent in the post-menopausal years.

Topamax®  may help reduce the frequency and severity of the cluster attacks but often takes a few weeks to work. Other medications such as prednisone or verapamil may work a little quicker in controlling the attacks if not contraindicated by any other medical problems.

Robert Kunkel, MD
Center for Headache and Pain Neurological Institute
Cleveland Clinic
Cleveland, Ohio

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