From the FDA Drug Label
The efficacy of IMITREX Injection in the acute treatment of cluster headache was demonstrated in 2 randomized, double-blind, placebo-controlled, 2-period crossover trials. Headache relief was defined as a reduction in headache severity to mild or no pain. In both trials, the proportion of individuals gaining relief at 10 or 15 minutes was significantly greater among patients receiving 6 mg of IMITREX Injection compared with those who received placebo
The treatment of cluster headache with sumatriptan (SQ) is effective, with headache relief achieved in a significantly greater proportion of patients compared to placebo at 10 and 15 minutes after injection.
- Key points:
- Dose: 6 mg of IMITREX Injection
- Time to relief: 10 and 15 minutes after injection
- Efficacy: significantly greater than placebo 1
From the Research
The treatment of cluster headache should prioritize high-flow oxygen therapy and subcutaneous sumatriptan for acute attacks, and verapamil for prevention, as recommended by the most recent guidelines 2.
Acute Treatment
For acute cluster headache attacks, the following options are recommended:
- High-flow oxygen therapy (100%) with a flow of at least 12 L/min over 15 min 2, 3, 4
- Subcutaneous sumatriptan (6mg) 2, 5, 6
Preventive Treatment
For prevention of cluster headache attacks, the following options are recommended:
- Verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) 2, 5, 6
- Corticosteroids, such as prednisone (at least 100 mg orally or up to 500 mg iv per day over 5 days) 2
- Alternative treatments, including lithium, topiramate, and galcanezumab (only for episodic cluster headache) 2, 5, 6
Additional Considerations
- Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache 2
- Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile 2
- Lifestyle modifications, including avoiding alcohol during cluster periods and maintaining regular sleep patterns, are also important [@Example@]