What are the treatment options for cluster headaches?

From the Guidelines

Cluster headaches can be effectively treated with high-flow oxygen therapy, which should be offered to treat acute attacks at a flow rate of 12 L/min via a non-rebreather mask 1. When considering treatment options for cluster headaches, it's essential to prioritize therapies that provide quick and safe relief.

• High-flow oxygen therapy is a first-line option for acute treatment, with a recommended flow rate of 12 L/min via a non-rebreather mask, as supported by the British Thoracic Society guidelines 1.
• This treatment approach is crucial in managing acute attacks of cluster headaches, and appropriate equipment should be provided to ensure delivery of the high flow rate oxygen.
• Patients typically have warning of an impending cluster headache attack, allowing for urgent installation of home oxygen, if available, rather than a permanent home supply.
• The use of high-flow oxygen therapy in cluster headaches is a well-established practice, with guidelines recommending its use as a Grade A treatment option 1.
• In real-life clinical practice, it's essential to prioritize this treatment option due to its effectiveness and safety profile, as evidenced by the highest quality study available 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 treatment option for cluster headaches is sumatriptan (SQ) 6 mg. This dose has been shown to provide significant relief from cluster headache symptoms within 10 to 15 minutes of administration 2.

From the Research

Treatment Options for Cluster Headaches

The treatment options for cluster headaches can be categorized into acute treatment, prophylaxis, and transitional treatment.

• Acute treatment options include:
  • Oxygen therapy: 100% oxygen with a flow of at least 12 L/min over 15 min 3, 4, 5
  • Subcutaneous sumatriptan: 6 mg 3, 6, 7
  • Intranasal triptans: such as zolmitriptan 6, 7
• Prophylaxis options include:
  • Verapamil: at a daily dose of at least 240 mg 3, 6, 7
  • Lithium: with liver and kidney functioning evaluation before and during treatment 3, 6, 7
  • Topiramate: as a second choice if verapamil and lithium are ineffective or contraindicated 3, 6, 7
  • Galcanezumab: for episodic cluster headache 3, 6, 7
• Transitional treatment options include:
  • Greater occipital nerve block: as the most proven transitional treatment 3, 6
  • High-dose prednisone: such as at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days 3, 6
  • Frovatriptan: as an alternative option 6

Non-Pharmacological Treatment Options

Non-pharmacological treatment options include:

• Noninvasive vagus nerve stimulation: efficacious in episodic but not chronic cluster headache 3
• Electrical stimulation of the greater occipital nerve: not recommended due to the side effect profile 3
• Home oxygen concentrators: as an alternative to conventional oxygen therapy using a tank 5