What are the treatment options for cluster headaches?

From the Guidelines

High-flow oxygen therapy (12 L/min via a non-rebreather mask) should be offered to treat acute attacks of cluster headache (CH). This recommendation is based on the British Thoracic Society guidelines for home oxygen use in adults 1. The use of oxygen therapy in cluster headaches has been shown to be effective in aborting attacks.

Key Treatment Options

• High-flow oxygen therapy (12 L/min via a non-rebreather mask) for acute attacks
• Other treatment options may include injectable or nasal sumatriptan, zolmitriptan nasal spray, and local anesthetics like lidocaine nasal drops
• Preventive strategies during cluster periods may involve verapamil, prednisone, lithium, and greater occipital nerve blocks with steroids and lidocaine

Important Considerations

• Appropriate equipment should be provided to ensure delivery of high flow rate oxygen at 12 L/min for CH using a non-rebreather mask 1
• Patients should be educated on the use of oxygen therapy and other treatment options to manage their cluster headaches effectively
• Treatment should be individualized based on attack frequency, medical history, and patient preference, with a focus on minimizing morbidity, mortality, and improving quality of life.

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 treatment options for cluster headaches include sumatriptan (SQ) 6 mg. Key points about this treatment option are:

• Efficacy: 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.
• Dosing: A 6 mg dose of sumatriptan is effective for the acute treatment of cluster headache.
• Onset of relief: Relief can be achieved as early as 10 minutes after injection.
• Pain relief: Headache relief was defined as a reduction in headache severity to mild or no pain. 2

From the Research

Cluster Headache Symptoms and Treatment Plan

• Cluster headaches are characterized by severe, unilateral pain and cranial autonomic symptoms, with rapid onset and frequent attacks 3, 4.
• The current licensed treatment for acute attacks includes subcutaneous sumatriptan and high-flow inhaled oxygen 4, 5.

Treatment Options

• Acute treatment options:
  • High-flow inhaled oxygen (100% at 12 L/min for 15 minutes) 4, 5
  • Subcutaneous sumatriptan (6 mg) 3, 6, 5
  • Intranasal zolmitriptan (10 mg) 3, 6, 7
  • Subcutaneous or intramuscular dihydroergotamine 7
  • Intranasal sumatriptan 7
• Prophylactic treatment options:
  • Verapamil (at a daily dose of at least 240 mg) 5, 7
  • Lithium 5, 7
  • Corticosteroids (at least 100 mg prednisone or equivalent) 5
  • Topiramate 5
  • Galcanezumab (for episodic cluster headache) 5
• Transitional therapy options:
  • Short courses of high-dose oral corticosteroids 7
  • Dihydroergotamine 7
  • Occipital nerve blocks with local anesthetic and steroids 7

Non-Pharmacological Treatment Options

• Noninvasive vagus nerve stimulation (for episodic cluster headache) 5
• Greater occipital nerve block 5