From the Guidelines
Cluster headaches are typically treated with abortive medications such as subcutaneous sumatriptan or intranasal zolmitriptan, as well as normobaric oxygen therapy.
Treatment Options
- Abortive medications:
- Normobaric oxygen therapy: for the short-term treatment of cluster headache 1
- Noninvasive vagus nerve stimulation: may be suggested for the short-term treatment of episodic cluster headache 1
Non-Pharmacologic Therapy
- Aerobic exercise or progressive strength training: may be suggested for the prevention of tension-type and migraine headache, but its effectiveness for cluster headache is unclear 1
- Physical therapy: is suggested for the management of tension-type, migraine, or cervicogenic headache, but its effectiveness for cluster headache is unclear 1 Note that there is insufficient evidence to recommend for or against other non-pharmacologic therapies such as biofeedback, cognitive behavioral therapy, mindfulness-based therapies, progressive muscle relaxation, acupuncture, dry needling, yoga, or dietary trigger avoidance for the treatment and/or prevention of cluster headache 1
From the Research
Treatment Options for Cluster Headaches
The treatment for cluster headaches can be divided into several categories, including:
- Acute treatments: aimed at relieving the pain of a cluster headache attack
- Bridge treatments: used to transition from acute to preventive treatment
- Preventive treatments: aimed at reducing the frequency and severity of cluster headache attacks
Acute Treatments
Acute treatments for cluster headaches include:
- Inhalation of oxygen 2, 3, 4, 5
- Subcutaneous sumatriptan 2, 3, 4, 5
- Non-invasive vagus nerve stimulation 4, 5
Preventive Treatments
Preventive treatments for cluster headaches include:
- Verapamil 2, 3, 4, 5
- Corticosteroids 3, 4, 5
- Lithium 3, 5
- Topiramate 3, 5
- Galcanezumab (for episodic cluster headache) 4, 5
Surgical Interventions
Surgical interventions, such as hypothalamic deep brain stimulation and occipital nerve stimulation, may be considered for patients with chronic refractory cluster headaches 2, 3, 4