What are the treatment options for Cluster Headaches?

From the Guidelines

Cluster Headaches can be treated with abortive therapies such as subcutaneous sumatriptan or intranasal zolmitriptan, as well as normobaric oxygen therapy.

Treatment Options

• Abortive Therapies:
  • Subcutaneous sumatriptan (6 mg) 1
  • Intranasal zolmitriptan (10 mg) 1
  • Normobaric oxygen therapy 1

Rationale

The suggested treatments are based on the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline for the management of headache, which provides evidence-based recommendations for the treatment of cluster headaches 1.

Important Considerations

• The guideline suggests these treatments with a "weak for" recommendation, indicating that the benefits of these treatments outweigh the harms, but the evidence is not strong enough to make a definitive recommendation 1.
• The use of these treatments should be individualized and based on patient preferences and values.
• Clinicians should be aware of the potential side effects and contraindications of these treatments, such as the risk of serotonin syndrome with triptans 1.

From the Research

Treatment Options for Cluster Headaches

The treatment options for cluster headaches can be broadly divided into acute, bridge, and preventive treatments.

• Acute treatments are primarily delivered via rapid, non-oral routes such as inhalation, nasal, or subcutaneous routes 2.
• Bridge treatments include corticosteroids (oral or suboccipital injections) 2, 3.
• Preventive treatments include a variety of unrelated treatments such as verapamil, galcanezumab, and neuromodulation 2, 4, 3, 5.

Acute Treatments

Common acute treatments for cluster headaches include:

• Subcutaneous sumatriptan 2, 3, 5
• High-flow oxygen 2, 3, 5
• Non-invasive vagus nerve stimulation 2, 4
• Triptans (such as intranasal triptans) 4, 3

Preventive Treatments

Common preventive treatments for cluster headaches include:

• Verapamil 2, 4, 3, 5
• Galcanezumab 2, 4, 3
• Corticosteroids (oral or suboccipital injections) 2, 3
• Lithium 3
• Topiramate 3
• Melatonin, clomiphene, dihydroergotamine, and pizotifen may also be considered, although the evidence level is low 3

Neuromodulation

Neuromodulation is becoming an increasingly popular option for treating cluster headaches, including:

• Non-invasive vagus nerve stimulation 2, 4
• Occipital nerve stimulation 2
• Hypothalamic deep brain stimulation may be considered for chronic refractory cases 5