From the Guidelines
Cluster headaches should be treated with subcutaneous sumatriptan (6 mg) or intranasal zolmitriptan (10 mg) for acute attacks, and galcanezumab can be considered for prevention of episodic cluster headache. Cluster headaches are severe, one-sided headaches characterized by intense pain around one eye, accompanied by autonomic symptoms like tearing, nasal congestion, and eyelid drooping. Treatment focuses on both acute pain relief and prevention.
Acute Treatment
For acute attacks, the following options are available:
Prevention
For prevention during cluster periods, the following options can be considered:
- Galcanezumab for episodic cluster headache 1 Note that verapamil is often used in clinical practice, but there is insufficient evidence to recommend for or against verapamil for the prevention of episodic or chronic cluster headache 1. Cluster headaches typically occur in cycles lasting weeks to months with pain-free remission periods, and are thought to involve hypothalamic dysfunction affecting the trigeminal-autonomic reflex. Avoiding alcohol during cluster periods is crucial as it can trigger attacks. Patients should establish a relationship with a neurologist experienced in headache management for optimal care.
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. Patients age 21 to 65 were enrolled and were instructed to treat a moderate to very severe headache within 10 minutes of onset 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
Cluster Headache Treatment with Sumatriptan: Sumatriptan (SQ) is effective in the acute treatment of cluster headache. In clinical trials, patients receiving 6 mg of sumatriptan injection had a significantly greater proportion of individuals gaining relief at 10 or 15 minutes compared to those receiving placebo 2.
- Key Findings:
- Significant relief at 10 or 15 minutes
- Effective in treating moderate to very severe headaches
- Relief defined as reduction in headache severity to mild or no pain
- Dosage: 6 mg of sumatriptan injection
- Population: Patients aged 21 to 65 with moderate to very severe cluster headaches.
From the Research
Cluster Headache Treatment Options
- Acute treatment options for cluster headache include:
- Preventive treatment options for cluster headache include:
- Transitional treatments, such as corticosteroids, can be useful for suppressing resistant cluster periods 5, 6
- Lifestyle changes, including alcohol avoidance, sleep hygiene, and use of vasodilation drugs, should be considered 6
Efficacy of Treatment Options
- Triptans, such as zolmitriptan and sumatriptan, have been shown to be effective in the acute treatment of cluster headaches, with a number needed to treat (NNT) of 2.4 for 15 minute pain relief with subcutaneous sumatriptan 6 mg 3
- Verapamil has been recommended as a first-line preventive treatment for cluster headache, with a daily dose of at least 240 mg 5
- Corticosteroids, such as prednisone, have been shown to be efficacious in cluster headache, with a recommended dose of at least 100 mg per day 5
Non-Pharmacological Treatment Options
- Noninvasive vagus nerve stimulation has been shown to be efficacious in episodic cluster headache 5
- Greater occipital nerve block has been recommended as a treatment option for cluster headache 5
- Hypothalamic deep brain stimulation has been considered as a surgical procedure for the chronic refractory form of the disorder 7