In prevention of cluster headaches

Verapamil, the preferred calcium channel blocker for the prevention of cluster headaches, is effective in approximately 70% of patients." The... 

Lithium carbonate is effective against episodic and chronic cluster headache attacks, with beneficial effects often appearing during the first week of therapy. A positive response is seen in up to 78% of patients with chronic cluster headache and in up to 63% of patients with episodic cluster headache." The usual dose of lithium for cluster headache is 600 to 900 mg/day administered in divided doses. Tachyphylaxis to lithium has been reported occasionally during prolonged therapy." Optimal plasma lithium levels for the prevention of cluster headache have not been established, but efficacy has been reported at relatively low serum concentrations (0.3-0.8 mEq/L)." ... 

In a small, open study of topiramate for the prevention of cluster headache in 12 Asians, the initial dose was 50 mg bd, increasing by 50-100 mg/day every 3-7 days to a maximum of 400 mg/day. Adverse reactions included paresthesia (84%), slow speech (54%), and dizziness (46%). Two patients withdrew because of adverse events. 

Ergotamine can be an efficacious agent for prophylactic as well as abortive therapy of cluster headaches." A 2-mg bedtime dose is often beneficial for the prevention of nocturnal headache attacks. Daily use of 1 to 2 mg ergotamine alone or in combination with verapamil or lithium may provide effective headache prophylaxis in patients refractory to other agents with little risk of ergotism or rebound headache." - ... 

The authors commented that the manic symptoms had probably been caused by glucocorticoids or glucocorticoid withdrawal. They concluded that patients with cluster headache and a history of affective disorder should not be treated with glucocorticoids, but with valproate or lithium, which are effective in both conditions. Lamotrigine, an anticonvulsive drug with mood-stabilizing effects, may prevent glucocorticoid-induced mania in patients for whom valproate or lithium are not possible (101). 

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