Q. My husband has been suffering with chronic cluster headache for almost five years. He has been on just about every medication there is and finally took himself off all but Imitrex® injections and pain medications. We found that the preventive medications didn’t stop the headaches but kept him “messed up” even when he wasn’t having a headache. His headaches last over an hour (usually several hours), even with the use of Imitrex and pain medications. He is pitiful really. He tries to live his life as normally as possible, but it becomes increasingly more difficult. Recently, I saw an article on the use of baclofen for cluster. What are your thoughts on this?

A. The treatment of chronic cluster is challenging. Even when patients go into a remission, they are prone to recurrence despite ongoing treatment. In some cases, previous therapeutic approaches that had failed can again become effective. Aggressive medical therapies to try to interrupt the cluster headaches, such as dihydroergotamine or histamine, have been used with success. Some patients have undergone surgical procedures as well. The use of baclofen, a medication originally used for relief of spasticity in multiple sclerosis, has proven useful in trigeminal neuralgia and, in one study, 12 out of 16 patients who were treated with this agent at doses of 15 to 30 mg per day had resolution of their cluster headache cycle within a week. Several of these patients took the treatment again at a later date when their cluster headaches recurred and had success again.

-Frederick Freitag, D.O.
Diamond Headache Clinic, Chicago, IL