Cluster Headache—Acute and Prophylactic Therapy

Avi Ashkenazi, MD; Todd Schwedt, MD


Headache. 2011;51(2):272-286. 

In This Article

Prophylactic Therapy

Prophylactic therapy for CH is divided into maintenance prophylaxis and transitional prophylaxis. Maintenance prophylactic therapies are used throughout the entire course of the cluster period with the intent of reducing the frequency and severity of cluster attacks. When treating ECH, maintenance prophylactics are generally discontinued after resolution of the cluster period and then restarted at the onset of the next cluster period. Although maintenance prophylaxis monotherapy is optimal, some patients will require a combination of maintenance medications for adequate control of CH. However, care must be taken to avoid potentially negative drug interactions. Transitional prophylactics are administered for short durations as adjunctive therapies to maintenance prophylactics in an attempt to abort the cluster period or to further reduce the frequency and severity of cluster attacks. They are often begun simultaneously with initiation of maintenance prophylaxis because they tend to work more quickly and thus provide control of CH until the maintenance therapy has time to take effect.


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