Cluster Headache—Acute and Prophylactic Therapy

Avi Ashkenazi, MD; Todd Schwedt, MD


Headache. 2011;51(2):272-286. 

In This Article

Summary—Treatment of the Acute Attack

In summary, injectable sumatriptan and inhaled oxygen are both a first-line therapy for acute CH. The decision on which of these options to use should be made after considering the patient's medical comorbidities and personal preference. In patients who do not respond well to these treatments (or in those who cannot use triptans), somatostatin or its analogs appear to be a promising therapeutic option. Intranasal lidocaine may be tried as adjunctive therapy in refractory patients.

There are little data with regard to clinical parameters that may predict response to the various acute CH treatments. In a prospective study of 246 CH patients, older age was a predictor for decreased response to triptans, whereas nausea, vomiting, and restlessness predicted decreased response to oxygen.[31] As opposed to migraine, there are few known triggers to the acute CH attack, most notable of which is alcohol. Patients should be advised to avoid alcoholic beverages during a cluster period (or, in the case of CCH, to avoid it altogether).


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