From the Guidelines
Cluster headache treatment should prioritize high-flow oxygen therapy, delivering 12 L/min via a non-rebreather mask, as recommended by the British Thoracic Society guidelines 1. Cluster headaches are extremely painful headaches characterized by severe pain on one side of the head, typically around the eye, along with autonomic symptoms like tearing, nasal congestion, and eyelid drooping.
- Key characteristics of cluster headaches include:
- Severe pain on one side of the head
- Autonomic symptoms like tearing, nasal congestion, and eyelid drooping
- Attacks lasting 15-180 minutes and happening 1-8 times daily during cluster periods
- For acute treatment, high-flow oxygen therapy is highly effective and safe, with a flow rate of 12 L/min via a non-rebreather mask, as supported by the British Thoracic Society guidelines 1.
- Other treatment options, such as sumatriptan injections or nasal spray, zolmitriptan nasal spray, and preventive medications like verapamil, prednisone, and lithium, may also be considered, but high-flow oxygen therapy should be the first line of treatment.
- Additionally, patients should avoid alcohol during cluster periods as it can trigger attacks, and maintain regular sleep patterns to reduce headache frequency.
- It is essential to provide appropriate equipment to ensure delivery of high-flow rate oxygen at 12 L/min for cluster headache treatment using a non-rebreather mask, as highlighted in the British Thoracic Society guidelines 1.
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
The symptoms of cluster headaches that can be treated with sumatriptan include moderate to very severe headache. The treatment for cluster headaches with sumatriptan is 6 mg of IMITREX Injection. Headache relief can be achieved in a significant proportion of patients within 10 or 15 minutes of treatment with sumatriptan. Key points about the treatment of cluster headaches with sumatriptan include:
- Rapid relief: Sumatriptan can provide rapid relief from cluster headache symptoms.
- Effective dose: The effective dose of sumatriptan for cluster headache treatment is 6 mg.
- Significant relief: A significant proportion of patients can achieve relief from cluster headache symptoms within 10 or 15 minutes of treatment with sumatriptan 2.
From the Research
Cluster Headache Symptoms
- Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life 3
- Cluster headache attacks involve severe unilateral pain in the trigeminal distribution together with ipsilateral cranial autonomic features and a sense of agitation 4
- The disorder affects approximately 0.1% of the population worldwide 4
Treatment Options
- For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan 3
- Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended 3
- Corticosteroids are efficacious in cluster headache, with a recommended dose of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days 3
- Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments 3
- Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache 3
- Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile 3
Acute Treatment
- High-flow inhaled oxygen is an effective treatment for acute cluster headache attacks, with a significant difference in pain relief compared to placebo 5
- Inhalation of 100% oxygen at 6-12 L/min for 15-30 min using a non-rebreather face mask is one of the most effective acute therapies for cluster headache 6
- Subcutaneous administration of sumatriptan and intranasal application of sumatriptan or zolmitriptan are also options for acute treatment 7
Preventive Treatment
- Verapamil and lithium are the best-documented drugs for preventive treatment of cluster headache 7
- Possibly effective drugs for preventive treatment include gabapentin, topiramate, divalproex sodium, and melatonin 7
- Monoclonal antibodies to the calcitonin gene-related peptide have shown efficacy for episodic cluster headache 7