From the Guidelines
Cluster headache treatment typically involves abortive therapies, such as subcutaneous sumatriptan or intranasal zolmitriptan, as well as normobaric oxygen therapy.
Abortive Therapies
- Subcutaneous sumatriptan (6 mg) is suggested for the short-term treatment of cluster headache 1
- Intranasal zolmitriptan (10 mg) is also suggested for the short-term treatment of cluster headache 1
Nonpharmacologic Therapy
- Normobaric oxygen therapy is suggested for the short-term treatment of cluster headache, with a specific recommendation of high flow oxygen therapy (12 L/min via a non-rebreather mask) 1
- Noninvasive vagus nerve stimulation is suggested for the short-term treatment of episodic cluster headache 1
Additional Considerations
- Physical therapy, aerobic exercise, and progressive strength training may be beneficial for headache management, but the evidence is not specific to cluster headache 1
- There is insufficient evidence to recommend other behavioral interventions, such as biofeedback, cognitive behavioral therapy, or mindfulness-based therapies, for the treatment and/or prevention of headache 1
From the Research
Treatment Strategies for Cluster Headache
The treatment of cluster headache can be divided into several strategies, including:
- Abortive therapy: aimed at relieving individual attacks 2
- Transitional therapy: short-term use of fast-acting agents to bridge the gap between acute attacks and preventive therapy 3, 4
- Preventive therapy: aimed at preventing recurrent attacks during the cluster period 2, 3, 4, 5
Acute Treatments
Acute treatments for cluster headache include:
- Inhalation of oxygen 3, 4, 5
- Triptans, such as sumatriptan 3, 4, 5
- Dihydroergotamine 3, 4
- Non-invasive vagus nerve stimulation 5, 6
Preventive Treatments
Preventive treatments for cluster headache include:
- Verapamil: the mainstay of prophylactic therapy 3, 4, 5
- Corticosteroids: used as bridge therapy or preventive treatment 3, 4, 5
- Lithium: used as an alternative to verapamil 3, 4
- Divalproex sodium: used as an alternative to verapamil 3, 4
- Galcanezumab: a monoclonal antibody approved for episodic cluster headache 5, 6
- Occipital nerve stimulation: used for treatment-refractory chronic cluster headache 3, 5
Other Treatment Options
Other treatment options for cluster headache include: