Conflict of Interest: None.
Headache Currents—Clinical Review
Cluster Headache: Conventional Pharmacological Management
Article first published online: 14 JUN 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 53, Issue 7, pages 1191–1196, July/August 2013
How to Cite
Becker, W. J. (2013), Cluster Headache: Conventional Pharmacological Management. Headache: The Journal of Head and Face Pain, 53: 1191–1196. doi: 10.1111/head.12145
- Issue published online: 18 JUL 2013
- Article first published online: 14 JUN 2013
- Manuscript Accepted: 10 MAY 2013
- cluster headache;
- prophylactic medication;
- transitional medications
Cluster headache pain is very intense, usually increases in intensity very rapidly from onset, and attacks are often frequent. These clinical features result in significant therapeutic challenges. The most effective pharmacological treatment options for acute cluster attack include subcutaneous sumatriptan, 100% oxygen, and intranasal zolmitriptan. Subcutaneous or intramuscular dihydroergotamine and intranasal sumatriptan are additional options. Transitional therapy is applicable mainly for patients with high-frequency (>2 attacks per day) episodic cluster headache, and options include short courses of high-dose oral corticosteroids, dihydroergotamine, and occipital nerve blocks with local anesthetic and steroids. Prophylactic therapy is important both for episodic and chronic cluster headache, and the main options are verapamil and lithium. Verapamil is drug of first choice but may cause cardiac arrhythmias, and periodic electrocardiograms (EKGs) during dose escalation are important. Many other drugs are also in current use, but there is an insufficient evidence base to recommend them.