Materiały źródłowe

• #1 Cluster headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084

  There’s no cure for cluster headaches. The goal of treatment is to decrease the pain, shorten the headache period and prevent new attacks. […] Because the pain of a cluster headache tends to come on suddenly and go away quickly, it can be hard to treat. Treatment requires fast-acting medicines. […] These treatments aim to stop a cluster headache once it’s begun: […] Breathing in pure oxygen through a mask provides relief for most who use it. People feel the effects of this safe treatment within 15 minutes. […] Sumatriptan (Imitrex) is given as a shot when cluster headache symptoms start. […] Octreotide (Sandostatin), a shot of a version of the brain hormone somatostatin, works for some people with cluster headache. […] The numbing effect of local anesthetics, such as lidocaine, might work against cluster headache pain in some people when given through the nose.

• #1 Cluster headache – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cluster-headache/diagnosis-treatment/drc-20352084

  A form of dihydroergotamine given through a vein might help relieve pain for some people with cluster headache. […] Preventive therapy starts at the onset of the cluster period with the goal of stopping the attacks. […] The calcium channel blocking agent verapamil (Calan SR, Verelan) is often the first choice for preventing cluster headache. […] These medicines, such as prednisone (Prednisone Intensol, Rayos), act fast to relieve cluster headaches. […] Galcanezumab (Emgality) is given as a monthly shot until the cluster period ends. […] This medicine is used to treat bipolar disorder. It might help prevent long-lasting, known as chronic, cluster headache. […] Noninvasive VNS uses a hand-held controller to send electrical stimulation to the vagus nerve through the skin. […] This involves a shot of pain-relieving medicine into the back of the head. […] Rarely, surgery might help people with chronic cluster headaches who don’t get relief from other treatments. […] Researchers are studying other ways of treating cluster headache, including a number of procedures that stimulate nerves.

• #2 Cluster Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544241/

  Cluster headaches are the most common of the primary headache type known as trigeminal autonomic cephalgia. […] This activity reviews the evaluation, treatment, and management of cluster headaches, including recognizing other forms of headache. Also, it assesses the approved abortive treatments and prophylactic management and distinguishes them from common treatments with poor supporting evidence. […] Perhaps the most well-known treatment for cluster headaches is 100% oxygen therapy. This approach is a level A recommendation and is unique to cluster headaches vs. all other types of headaches. At least 66% of patients respond to oxygen therapy. It is effective in less than 10 minutes. Oxygen use carries no risks or side effects, making it an excellent choice for treatment. […] Triptans are the only other level A recommended treatment. Delivery of these drugs can be subcutaneous sumatriptan or zolmitriptan delivered via nasal spray.

• #3 Managing cluster headache | Practical Neurology

  https://pn.bmj.com/content/19/6/521

  Cluster headache is a neurological disorder that presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. This article aims to guide general neurologists to an accurate diagnosis and practical management options for cluster headache patients. […] Management of cluster headache is broadly divided into acute and preventive; furthermore, there are novel neuromodulation devices that can be used for either. […] The evidence-based acute treatments for cluster headaches are subcutaneous sumatriptan, intranasal sumatriptan and zolmitriptan, high-flow oxygen via a non-rebreather mask and, in episodic cluster alone, non-invasive vagus nerve stimulation (nVNS). […] Patients may use interim measures while waiting for a preventive treatment to have therapeutic effect; such measures may also help patients with episodic cluster headache with short bouts.

• #3 Managing cluster headache | Practical Neurology

  https://pn.bmj.com/content/19/6/521

  Verapamil was found to be effective initially in an open-label study and subsequently in two randomised clinical trials. It is widely accepted as the first-line preventive treatment for cluster headache, typically starting with 80 mg three times a day with view to increasing it by 80 mg every 2 weeks according to response; the maximum recommended dose is 320 mg three times a day. […] Lithium is generally accepted as a reasonable second-line option. […] Melatonin 10 mg at night can help to prevent attacks of episodic cluster headache. […] Neuromodulation is a useful development for treating cluster headache for patients in whom oral preventive therapy was either ineffective or contraindicated. […] The gammaCore (nVNS) device has shown efficacy of using three 2 min ipsilateral stimulations of the cervical branch of the vagus nerve, in acute treatment for cluster headache attacks in an open-label study and has proven efficacy for the acute treatment in episodic cluster headache in two double-blind sham-controlled randomised studies.

• #3 Managing cluster headache | Practical Neurology

  https://pn.bmj.com/content/19/6/521

  The SPG has been a target for different therapeutic options for a long time. However, an implantable small stimulator in the pterygopalatine fossa has shown efficacy for aborting acute cluster attacks in a randomised double-blind sham-controlled trial for medically refractory chronic cluster headache. […] Accurate diagnosis is key and the management of cluster headache is rapidly changing, with novel treatment options that are more specific to cluster headache. […] Patients may find useful information on the UK patient group website: Organisation for the Understanding of Cluster Headache- OUCH(UK).

• #4 Cluster Headache Treatment Options | AMF

  https://americanmigrainefoundation.org/live-copy/resource-library/cluster-headache-treatment-options/

  There are a variety of available cluster headache treatment options that can help provide relief. […] Dr. Tepper has one important piece of advice for patients living with cluster headache: Get to a headache specialist. […] While cluster headache experiences can vary, in most cases it can be successfully treated by individualizing acute and preventive drug treatment. […] It’s important to note that only sumatriptan and dihydroergotamine injections are FDA-approved for acute treatment of CH, while galcanezumab is approved for the prevention of episodic cluster. […] It is important to work with your doctor to arrive at the treatment plan that’s right for you. […] Acute treatments for cluster headache include: […] Dr. Tepper says one of the most, if not the most, effective treatment options for CH is oxygen.

• #4 Cluster Headache Treatment Options | AMF

  https://americanmigrainefoundation.org/live-copy/resource-library/cluster-headache-treatment-options/

  Sumatriptan six mg subcutaneous, sumatriptan 20 mg, and zolmitriptan five mg nasal sprays may be effective in the acute treatment of cluster headache, and can help shorten an acute attack. […] Intramuscular injections may be effective in the relief of acute attacks of CH. […] Lidocaine nasal drops may be used to treat acute attacks of CH. […] The options for preventive treatment in CH are determined largely by the length of the attack, as opposed to the designation of episodic versus chronic CH. […] Verapamil, a medication used to treat high blood pressure, is a commonly prescribed medication for CH prevention. […] Prednisone may be administered as a short-term bridge for 10-21 days, while waiting for the prevention medications to begin to work. […] Lithium carbonate is mainly used for chronic CH because of its side effects, although it is sometimes employed for the episodic variety. […] Studies have shown that topiramate can be an effective option for the preventive treatment of episodic and chronic cluster headache. […] Galcanezumab received approval from the FDA for preventive treatment of episodic cluster headache.

• #5 Cluster headache – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – ArrowVisualV1 – Arrow

  https://migrainetrust.org/understand-migraine/types-of-migraine/other-headache-disorders/cluster-headache/

  Treatment for cluster headache falls into two categories: […] Acute treatment to stop an attack when it’s happening. […] Preventive treatment to decrease the severity and prevent attacks. […] The main acute treatments for cluster headache are: […] Sumatriptan, 6 mg injection provides relief within 15 minutes […] High flow Oxygen, 100% at 7-15 litres/minute for 15-20 minutes is effective at stopping attacks. […] Some people who can’t tolerate these or find them ineffective may benefit from a triptan nasal spray – either sumatriptan or zolmitriptan. […] gammaCore, an electrical device, can be used as an acute or preventive treatment. It is not suitable for everyone. […] Verapamil is the preventive treatment of choice for cluster headache. It can cause abnormal heart rhythms in some people so regular monitoring, by taking a heart tracing (ECG) is required.

• #5 Cluster headache – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – ArrowVisualV1 – Arrow

  https://migrainetrust.org/understand-migraine/types-of-migraine/other-headache-disorders/cluster-headache/

  Besides verapamil, other options include: […] Greater Occipital Nerve (GON) block (an injection around a nerve at the back of the head)– has been found to be on average 50% effective in cluster headache and often provides relief while finding other long-term treatments. […] Corticosteroids – these can provide short-term relief. They shouldn’t be used long-term and are often used while finding other treatments that work. […] Other things that may be effective include lithium, melatonin, and Sphenopalatine Ganglion Stimulation. […] During a cluster bout many people find alcohol and strong smells can trigger an attack, it’s helpful to avoid these if possible.

• #6 Oxygen therapy may help people with cluster headaches | UCLA Health

  https://www.uclahealth.org/news/article/oxygen-therapy-may-help-people-with-cluster-headaches

  Oxygen therapy may help people with cluster headaches. The oxygen therapy your doctor recommended is the most common approach to treating this type of headache pain. The oxygen, at 100% concentration, is delivered via a face mask at the first signs of pain. It is estimated that 75% to 80% of patients report complete relief from pain after 15 to 20 minutes of oxygen treatment. Oxygen therapy has no side effects and is readily available in emergency rooms and many urgent care clinics. An oxygen cannister can also be kept at home. […] When oxygen is not available, a class of drugs known as triptans are often prescribed. For swift absorption, these are administered as a nasal spray or injection. […] Galcanezumab, a migraine drug, and the blood pressure medication verapamil may help prevent cluster headaches. Steroids, such as prednisone, may help extend periods of remission. Now that you have an accurate diagnosis, your doctor will advise you on the best treatment regimen.

• #7 Cluster Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0715/p122.html

  Cluster headache is more prevalent in men and typically begins between 20 and 40 years of age. Treatment focuses on avoiding triggers and includes abortive therapies, prophylaxis during the cluster period, and long-term treatment in patients with chronic cluster headache. Evidence supports the use of supplemental oxygen, sumatriptan, and zolmitriptan for acute treatment of episodic cluster headache. Verapamil is first-line prophylactic therapy and can also be used to treat chronic cluster headache. More invasive treatments, including nerve stimulation and surgery, may be helpful in refractory cases. […] First-line treatments for acute cluster headache include sumatriptan (Imitrex) and zolmitriptan (Zomig), alone or in combination, and supplemental oxygen. Verapamil at a minimum dosage of 240 mg per day is recommended to reduce headache severity and decrease the frequency of episodes during a cluster period. Verapamil and lithium are the mainstays of treatment for chronic cluster headache.

• #7 Cluster Headache | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0715/p122.html

  Effective management of cluster headache requires the integration of several strategies. Patient education is important, and should focus on managing or avoiding triggers, with an emphasis on smoking cessation, alcohol counseling, and lifestyle modification. Abortive treatments should be used to alleviate acute headaches. Prophylactic therapy should be started and continued for the duration of the expected cluster period, then tapered. Patients who have chronic cluster headache should continue maintenance medications indefinitely. More invasive treatment options, including surgical interventions, are used only when other treatment modalities are ineffective. […] Triptans and supplemental oxygen are first-line abortive therapies for cluster headache. A double-blind, randomized, placebo-controlled crossover trial showed that inhaled high-flow oxygen (12 L per minute) was more effective than placebo in eliminating pain at 15 minutes. One randomized, double-blind, placebo-controlled study found that a 6-mg subcutaneous dose of sumatriptan (Imitrex) has a number needed to treat (NNT) of 2.4 for pain relief at 15 minutes, with response in 75% of patients vs. 32% in those who received placebo. Verapamil at a minimum dosage of 240 mg per day is first-line prophylaxis for cluster headache. […] Verapamil and lithium are the mainstays of treatment for chronic cluster headache. A double-blind crossover study comparing verapamil and lithium reported a 50% reduction in the headache index for the verapamil group and a 37% reduction for the lithium group.

• #8 Cluster Headaches: Symptoms, Treatments, Causes vs Migraines

  https://www.medicinenet.com/cluster_headaches/article.htm

  The treatment of cluster headaches can be divided into two distinct categories — relief of the acute headache and prevention of future headaches. […] Oxygen delivery: Delivering oxygen by a face mask has been shown to help a majority of people within a short period. However, this can be unwieldy, and most people are unable or unwilling to transport oxygen canisters if they need to travel. […] Injectable sumatriptan (Imitrex, Alsuma, Samavel DosePro): This is beneficial in many patients with cluster headaches. This treatment is contraindicated in patients with cardiac disease or untreated hypertension. Nasal spray or oral versions of this medication have been less effective than the injectable. […] Dihydroergotamine: Given intravenously, can be extremely effective in treating a cluster headache, but can be difficult to administer acutely and cannot be used if a patient has used sumatriptan in the preceding 24 hours.

• #8 Cluster Headaches: Symptoms, Treatments, Causes vs Migraines

  https://www.medicinenet.com/cluster_headaches/article.htm

  Intranasal lidocaine: Has been suggested as a treatment option, but must be administered in a specific manner and is ineffective if not given correctly. […] Steroids: These can be extremely effective to decrease the headache cycle. Steroids should not be used frequently, and are for short-term use only as long-term use can lead to significant complications. […] Verapamil (Calan, Varelan), lithium (Lithobid, Eskalith), valproic acid (Depakote, Stavzor), topiramate (Topamax, Quedxy, Topiragen, Trokendi XR), and melatonin: Can all be of benefit in reducing the frequency and severity of cluster cycles. […] Surgery: For intractable cases has been suggested. Radiofrequency lesioning of the trigeminal ganglion can decrease cluster headache frequency but is associated with significant side effects and nerve loss.

• #9 Cluster headaches: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/172387

  Octreotide (Sandostatin): These are synthetic versions of somatostatin, a brain hormone. It is an effective treatment for cluster headaches that is safe for those with hypertension or heart disease. […] Local anesthetic nasal drops: Lidocaine (Xylocaine) is an effective treatment for cluster headaches. […] Surgery: This may be an option if drug treatments do not work, or if the person cannot tolerate the medications. […] People with cluster headaches take short- and long-term medications. […] Short-term drugs: People typically take short-term medications until one of the long-term medications start working. […] Long-term drugs: People may take long-term drugs throughout the cluster period, such as: Calcium channel blockers: People take these during the cluster period and then gradually reduce the dose, although some people may need to use them long term. […] Lithium carbonate: This is a treatment for bipolar disorder that is also effective in preventing chronic cluster headaches. […] Anti-seizure medications: These drugs also offer effective long-term treatments for cluster headaches. […] Vagus nerve stimulation may also be effective.

• #10 Cluster Headaches | Jan & Tom Lewis Migraine Treatment Program | Barrow Neurological InstituteGroup 5Group 49

  https://www.barrowneuro.org/condition/cluster-headaches/

  Cluster Headaches Treatments […] Like other primary headache disorders, cluster headaches are typically managed and treated with a combination of preventive and acute medications or therapies. The most commonly used preventive medication for the treatment of cluster headache is verapamil, which is a calcium channel blocker. Verapamil is frequently used for the treatment of high blood pressure, but it is often effective in decreasing the intensity, duration, and/or the number of cluster headaches experienced by the patient. It can be helpful in both episodic and chronic cluster headache. […] Other preventive medications that have shown to be effective in the treatment of cluster headache include: Lithium, Topiramate, Prednisone, Nerve blocks, Neuromodulation. […] More recently, galcanezumab (Emgality) has gained FDA approval for the treatment of cluster headache. Emgality is also used for the prevention of migraine headache, though the dose in cluster headache treatment is higher—300 mg monthly for cluster headache versus 120 mg monthly for migraine. […] Acute symptomatic treatment of cluster headache is meant to stop a cluster headache quickly once it begins. Triptans are a class of medications commonly used to provide fast relief for migraine and cluster headache pain. Specifically, the drug sumatriptan (Imitrex) may be given as an injection. […] Other medications used to treat cluster headaches can include: Nasal cannula oxygen, Dihydroergotamine (DHE) infusion, Octreotide, Lidocaine (Xylocaine) or other local anesthetics. […] Inhaling pure oxygen can provide substantial relief. However, some patients find oxygen canisters too bulky and inconvenient to have ready when a cluster headache strikes. […] Identifying and avoiding your triggers can help prevent cluster headaches. Documenting the following in a headache diary can help you identify your triggers: Day and time the pain began, What you ate and drank in the previous 24 hours, How much you slept, What you were doing when the pain began, How long the pain lasted, What made the pain stop.

• #11

  https://journals.lww.com/neur/fulltext/2021/69001/cluster_headache__what_s_new_.17.aspx

  Attacks should be treated with parenteral triptans and/or high flow oxygen, and prevented with verapamil as first line treatment. […] There are a number of effective acute and preventive treatment options. […] The most established effective acute treatments for cluster attacks are subcutaneous/intranasal triptans and inhaled high-flow oxygen. […] Subcutaneous sumatriptan is the most effective triptan for CH and can be given up to twice per day. […] High flow oxygen is also effective at terminating attacks. […] The most established and well evidenced preventive treatment for CH is verapamil and this should be used as the first line preventive medication. […] Verapamil is usually given starting at a dose of 240 mg daily in two or three divided doses and increased in 80-120 mg increments in two weekly intervals, up to a maximum dose of 960 mg daily.

• #11

  https://journals.lww.com/neur/fulltext/2021/69001/cluster_headache__what_s_new_.17.aspx

  Short term use of high dose corticosteroids has been used as a transitional treatment for many years with good effectiveness in clinical practice. […] Suboccipital injection targeting the greater occipital nerve (GON) using local anesthetic agents and/or corticosteroids are well tolerated and effective in the transitional treatment of CH. […] Non-invasive vagus nerve stimulation with the gammaCore device has been also trialed as a preventive treatment for CCH. […] Monoclonal antibodies targeting CGRP or its receptor have recent good quality evidence for the treatment of episodic and chronic migraine in multiple large randomized controlled trials. They have also recently been investigated for use in CH. […] Occipital nerve stimulation (ONS) involves peripheral stimulation of the occipital nerves by implanted suboccipital electrodes, which are connected to an implantable pulse generator sited in the subcutaneous tissue of the chest or abdomen.

• #12 Cluster headache in adults – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/cluster-headache-in-adults.html

  First-line, evidence-based, abortive treatments for cluster headache include triptans and high-flow 100% oxygen through a well-fitting mask. […] Other abortive treatments that have some supporting evidence in cluster headache include non-invasive stimulation of the vagal nerve. […] Preventive therapy may be indicated long term in patients with chronic cluster headache, or seasonally, in patients with episodic cluster headache, depending on their history. […] Immediate-release or controlled-release verapamil is first line, and its use is supported by a randomised controlled trial, in which 80% of patients had a halving of attack frequency and 26% were attack free. […] Lithium is considered second-line for the prevention of cluster headache. […] Topiramate showed efficacy in a single open-label trial, but while it is a reasonable third-line option, cognitive adverse effects may limit its use.

• #13 Cluster Headaches: Symptoms and Treatment

  https://patient.info/brain-nerves/headache-leaflet/cluster-headaches

  Lithium is more commonly used to treat bipolar disorder. It is not clear how it may help cluster headaches. It is most effective in chronic cluster headache. […] Methysergide can be effective in short-term bouts of cluster headache but cannot be used for more than six months at a time due to potential side-effects. […] Corticosteroids are used in a short burst for two to three weeks in decreasing amounts as a first step to break the headache cycle. […] Ergotamine is sometimes prescribed. It can be helpful in reducing attacks at night if taken at bedtime. Topiramate has also been reported to be useful in cluster headache. […] Nerve blocks are sometimes used in debilitating cluster headaches and these have been shown to be of benefit in around 50% of patients. […] There have been anecdotal suggestions that alternative therapies such as acupuncture can be helpful in the treatment and prevention of cluster headache but as yet there is no good-quality supporting evidence for this. Further research may be helpful in this area.

• #14 Cluster Headache Preventive Therapies

  https://practicalneurology.com/diseases-diagnoses/headache-pain/cluster-headache-preventive-therapies/31520/

  Many treatments commonly used in cluster headache are based on evidence from a small number of trials or on therapeutic evidence for migraine, which is more prevalent. […] We present evidence-based forms of preventive treatment for cluster headache as well as unconventional therapies and lifestyle factors. […] As with any headache or pain condition, effective acute and preventive therapies are both required for optimal disease management. […] Verapamil is the mainstay preventive therapy for cluster headache. […] Lithium is effective in cluster headache prevention, although its narrow therapeutic range and undesirable side effect profile make it a less common choice. […] The relatively mild side effect profile of melatonin makes it a good choice for patients with cluster headache who are unable to tolerate other options.

• #14 Cluster Headache Preventive Therapies

  https://practicalneurology.com/diseases-diagnoses/headache-pain/cluster-headache-preventive-therapies/31520/

  Civamide is a synthetic congener of capsaicin (the active compound of hot peppers), which is commonly used as a topical agent for treating pain. […] Warfarin therapy (international normalized ratio [INR] 1.5-1.9) induced remission in 50% of participants with CCH during a 12-week treatment period in a placebo-controlled, crossover pilot study. […] Several open-label trials have shown some efficacy for topiramate, gabapentin, and valproic acid for cluster headache, although these medications are not considered first-line for prevention. […] The use of triptans, particularly those with long half-lives (eg, naratriptan [8 hrs] or frovatriptan [26 hrs]), as prophylactic agents for cluster headache has been considered. […] Noninvasive vagal nerve stimulation with a handheld external device is FDA-approved for both acute and preventive treatment of cluster headache.

• #14 Cluster Headache Preventive Therapies

  https://practicalneurology.com/diseases-diagnoses/headache-pain/cluster-headache-preventive-therapies/31520/

  Because invasive procedures carry higher risk, deep brain stimulation (DBS) of the ipsilateral posterior hypothalamus is reserved for patients with the most refractory cluster headache. […] Given the need to uptitrate preventive therapies, transitional or bridge therapy may be needed. […] A randomized controlled trial studied serial cortivazol (3.75 mg in 1 mL saline; approximately equivalent to 50 mg of methylprednisolone) injections into the ipsilateral greater occipital nerve. […] In a retrospective analysis of oral prednisone tapers, 73% of patients had more than 50% relief and 58% of patients had complete relief. […] Treatment with dihydroergotamine (DHE) is usually reserved for patients with refractory headache, cluster or otherwise, because of the potential cardiovascular, gastrointestinal, and proemetic effects of treatment.

• #14 Cluster Headache Preventive Therapies

  https://practicalneurology.com/diseases-diagnoses/headache-pain/cluster-headache-preventive-therapies/31520/

  There are subpopulations of people with cluster headache who historically have poor responses or limitations to preventive therapies. […] Although approximately 50% of women with cluster headache who have been pregnant report improvement during pregnancy, management of cluster headache when it does persist in pregnancy is essential. […] Mainstay therapies for cluster headache prevention often lack rigorous evidence-based support for their use.

• #15 FDA approves first treatment for episodic cluster headache that reduces the frequency of attacks | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-episodic-cluster-headache-reduces-frequency-attacks

  The U.S. Food and Drug Administration today approved Emgality (galcanezumab-gnlm) solution for injection for the treatment of episodic cluster headache in adults. […] Emgality provides patients with the first FDA-approved drug that reduces the frequency of attacks of episodic cluster headache, an extremely painful and often debilitating condition, said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDAs Center for Drug Evaluation and Research. […] The effectiveness of Emgality for the treatment of episodic cluster headache was demonstrated in a clinical trial that compared the drug to placebo in 106 patients. […] During the three-week period, patients taking Emgality experienced 8.7 fewer weekly cluster headache attacks than they did at baseline, compared to 5.2 fewer attacks for patients on placebo. […] Emgality is given by patient self-injection.

• #16 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  During acute attacks of CH, the use of triptans is widely recommended. […] Another accessible and highly effective acute treatment is high-flow oxygen, which can be administered at the patient’s home or in the emergency room. […] Based on the high response rates, intranasal and subcutaneous triptans, and oxygen are considered first-line options for the acute treatment of CH attacks. […] In the transitional phase, using prednisone orally at 100 mg/day for five days and gradually decreasing the doses is recommended. […] Verapamil, a calcium channel blocker, is the first-choice pharmacological treatment for preventing episodic and chronic CH using at least 240 mg/day. […] The monoclonal antibody galcanezumab is also an FDA-approved preventive treatment option for CH (300 mg/month for two months).

• #16 Frontiers | Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2024.1373528/full

  For refractory CH, the use of invasive treatments such as sphenopalatine ganglion blockade with radiofrequency ablation or neuromodulation may be an option in these patients as in one case series it led to a decrease of pain in 31% at six months of follow-up after radiofrequency treatment or 75% at 24 months of follow-up after neuromodulation. […] Greater occipital nerve stimulation (ONS) has been successfully used in cases with chronic CH refractory to medical treatment.

• #17 Emgality for the Prevention of Migraine and Treatment of Cluster Headache

  https://www.webmd.com/migraines-headaches/emgality-migraine-cluster-headache

  Weekly cluster attacks reduced by 52%. During weeks 1 to 3 following treatment with Emgality, people had an average of 8.7 fewer attacks per week. Those who received placebo had about five fewer attacks per week. […] The majority had at least a 50% reduction in cluster headaches. Seventy-one percent of people taking Emgality had at least a 50% reduction in attacks. People taking placebo had a 53% reduction in cluster headache attacks.

• #18 Cluster Headache | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/cluster-headache/

  Approved by the U.S. Food and Drug Administration (FDA) for migraine prevention and also useful in cluster headaches. […] Administered in doses of 900 mg daily. […] If cluster headaches persist despite medical treatment, surgical options might be considered. […] Surgical treatment of cluster headaches might include: […] A lead is implanted over the occipital nerve in the back of the head/neck, which is connected to a battery-powered stimulator. […] Stimulation in this part of the brain counteracts the hyperactivity to reduce headache intensity and frequency. […] A last resort, this procedure has serious risk.

• #19 Drug Treatment of Cluster Headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8748342/

  Verapamil is the medication of choice as a preventive treatment in cluster headache. […] Lithium is the second choice for the prevention of cluster headache. […] There are predominantly case reports on the preventive therapy of cluster headache with topiramate. […] A randomized, double-blind, placebo-controlled study on the effect of sodium valproate in cluster headache included 96 patients. […] The first report on the use of gabapentin in a patient with refractory chronic cluster headache was published in 2000. […] Because of the circadian rhythm of cluster attacks, the use of melatonin for the prevention of cluster headache has also been investigated. […] In conclusion, only preventive therapy with verapamil and lithium has evidence from randomized studies. The other drugs mentioned here can be used on a trial-and-error basis based on co-morbidities and anticipated AEs.

• #20 Cluster headache – National Migraine Centre

  https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/cluster-headache/

  As this is a relatively rare condition, most people with cluster will need to see a headache specialist, which you can access through the NHS or the National Migraine Centre. […] Without expert help, many sufferers can go years without having access to either diagnosis or effective treatment. […] For episodic cluster, the usual starting regime is: Sumatriptan 6mg injection for each episode of pain, taken as soon as possible after the start of the pain. This normally works within minutes. […] High-dose prednisolone (60-100mg) taken daily after breakfast for a week, which should be rapidly tapered over two to three weeks. This usually ends the bout in around 70 per cent of cases and allows time for verapamil to start working. […] Verapamil 80mg or 120mg three times daily. Continue until the bout is over.

• #21 Cluster headache – Wikipedia

  https://en.wikipedia.org/wiki/Cluster_headache

  Recommended management includes lifestyle adaptations such as avoiding potential triggers. […] Treatments for acute attacks include oxygen or a fast-acting triptan. […] Measures recommended to decrease the frequency of attacks include steroid injections, galcanezumab, civamide, verapamil, or oral glucocorticoids such as prednisone. […] Nerve stimulation or surgery may occasionally be used if other measures are not effective. […] The recommended first-line preventive therapy is verapamil, a calcium channel blocker. […] Improvement can be seen in an average of 1.7 weeks for episodic cluster headache and 5 weeks for chronic cluster headache when using a dosage of ranged between 160 and 720 mg (mean 240 mg/day). […] Since these compounds are steroids, there is little evidence to support long-term benefits from glucocorticoids, but they may be used until other medications take effect as they appear to be effective at three days.

• #22 Cluster Headache | Cluster Headache: Symptoms, Causes & Treatments

  https://resources.healthgrades.com/right-care/migraine-and-headache/cluster-headache

  Preventive treatment aims to reduce the number of attacks once an episode begins. Preventive treatments may include the following: Verapamil (Calan, Veralan) is a common first-line medicine for preventive treatment. It is an oral medicine belonging to the calcium channel blocker class. Corticosteroids, such as prednisone, can be helpful for short-term use. Doctors typically avoid long-term use because serious side effects can become a problem. Lithium may be an option for chronic cluster headache. Melatonin is a supplement that may help cluster headache sufferers by helping to regulate sleep-wake cycles. Nerve block injections containing a local anesthetic and corticosteroid can provide relief while other preventive treatments are starting. This injection goes into the back of the head to numb the occipital nerve. Topiramate and other anti-seizure medicines may help some people with cluster headache. Galcanezumab and possibly other antibody drugs that block or inhibit CGRP, a substance that causes migraine pain. Galcanezumab (Emgality) has been approved for reducing migraine frequency, and is currently under study for cluster headache. […] Once an episode subsides, some of these medicines require a dose tapering before stopping them. This allows the doctor to slowly and safely lower the dose. If you take preventive treatment, check with your doctor to find out how to stop your medicine.

• #23 Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01660-8

  The effect is thought to occur through a modulatory effect on the nociceptive processing in trigeminal neurons via the trigemino-vascular system. […] Side effects of short term and long-term use are equal to oral use. […] Although there is no evidence from clinical trials, it is the authors clinical experience that frovatriptan and naratriptan may be used for transitional prophylaxis in cases where GON blocks are inefficient or contraindicated or as a short term mini-preventive in people with several nightly attacks and short bouts. […] An era of new specifically targeted treatments with few side effects are emerging in the headache field. […] cGRP antibodies are the first targeted medical treatment possibilities in CH based on a pathophysiological understanding of the disease. […] Neuromodulation has become an emerging and viable treatment option for medically treatment refractory CCH patients e.g. treatment failure of three preventive drugs.

• #24 Safe and Effective for Cluster Headache

  https://www.gammacore.com/for-cluster-headache/safe-effective-cluster-headache/

  Users experienced a 57% decrease in the frequency of acute medications, including inhaled oxygen use. […] A treatment consisting of 2 two-minute stimulations on the same side of the neck, twice daily (morning and night).* […] A treatment consisting of 2 two-minute stimulations on the same side of the neck as needed; repeat treatment if pain persists. […] *Additional treatments may be recommended for cluster headache and other trigeminal autonomic cephalalgias. […] Understanding these triggers can help you manage your condition more effectively. However, it’s important to remember that avoiding these triggers might not completely prevent attacks. That’s why having an effective treatment plan, like using gammaCore, is crucial in helping to manage and relieve the intense pain that comes with cluster headache. […] gammaCore made a huge difference and helped get his life back.

• #25 5 Things To Know About Cluster Headache > News > Yale Medicine

  https://www.yalemedicine.org/news/cluster-headaches

  Preventive treatments for cluster headache include verapamil (brand name Verelan), a medication also used to lower blood pressure, and galcanezumab (brand name Emgality). Other treatments that can shorten a cluster cycle or induce a period of remission in chronic cluster headache include steroids, such as prednisone, and injections of dihydroergotamine (DHE), a medication also used to treat migraine. […] Dr. Schindler and colleagues at Yale and the Veterans Affairs (VA) Connecticut Healthcare System in West Haven, CT, are currently studying how psilocybin (a psychedelic found in magic mushrooms) can be used to treat cluster headache, migraine, and post-traumatic headache (which can occur after a head injury). […] With cluster headache, treatment with three doses of psilocybin reduced cluster attack frequency by about 30% over a number of weeks in the trial, she adds.

• #26 Preventing Episodic Cluster Headaches with Emgality® or Psychedelics: What You Need to Know

  https://www.migrainedisorders.org/cluster-emgality-psychedelics/

  Out of 28 patients using psilocybin as a preventive or prophylactic, 25 reported going into remission, or that their cycles “terminated.” […] Of the 8 patients using LSD as a preventive or prophylactic, 7 reported going into remission. […] Researchers found that the compound BOL-148 could be an effective, non-hallucinogenic treatment for cluster headaches and that it warrants more research. […] There is an ongoing clinical trial at Yale University on the impact of a single dose of psilocybin mushrooms on cluster headache patients. […] The last two decades have produced promising results for preventing cluster headaches. Emgality made history in 2019 when it became the first drug to gain FDA-approval for Episodic Cluster Headache. […] Both episodic and chronic patients have hope on the horizon with the psychedelic research into psilocybin mushrooms and LSD.

• #27 Cluster Headache Natural Treatment: Everything You Need to Know

  https://www.healthline.com/health/cluster-headache-natural-treatment

  While cluster headaches are most often managed with medications and other medical interventions, there may be some things you can also do at home to help ease or prevent symptoms. […] Currently, there are few home remedies that are effective and no known cures. […] Melatonin supplements at doses between 10 and 25 milligrams may help to prevent cluster headaches when taken before bedtime. However, melatonin treatment may be less effective in people with chronic cluster headaches. […] Topical capsaicin cream can be purchased over the counter and may be used to help manage cluster headaches. […] Oxygen therapy is one of the main treatments for a cluster headache attack. Getting extra oxygen into your bloodstream can calm your body and help you manage pain. […] A small older study involving 22 people with cluster headaches showed that magnesium sulfate gave meaningful relief to 41 percent of participants.

• #28 Cluster Headaches Causes, Symptoms and Treatments – Dr. Axe

  https://draxe.com/health/cluster-headaches/

  Sumatriptan is typically used in the treatment of migraine headaches. […] Natural remedies for cluster headaches include certain supplements and lifestyle changes. […] People who suffer from cluster headaches typically have low blood levels of magnesium and can benefit from magnesium supplementation or injections. […] Vitamin B2 may decrease the severity and frequency of cluster headaches. […] Melatonin is used as an adjunctive therapy in patients with cluster headaches who have incomplete relief of their headaches when using conventional treatments. […] Apply a small amount of capsaicin cream to the inside of your nostril (the same side thats experiencing the pain). […] These psychedelic mushrooms may seem like a strange natural treatment for incredibly painful cluster headaches, but many sufferers are turning to psilocybin mushrooms for relief when nothing else has worked.

• #28 Cluster Headaches Causes, Symptoms and Treatments – Dr. Axe

  https://draxe.com/health/cluster-headaches/

  Daily exercise can reduce stress and boost blood circulation. […] A 2020 study revealed that cluster headaches can often begin during your sleep cycles, and they may be related to sleep apnea. […] Alcohol and tobacco use can increase the frequency of cluster headache attacks and make the pain even worse. […] There are a number of conventional treatments for cluster headaches; they mainly focus on reducing pain and frequency of cluster headache attacks. […] Some natural remedies, such as magnesium and vitamin B2 supplements, capsaicin cream and melatonin, have proven to be effective against cluster headaches.

• #29 Cluster Headache Treatment & Management: Approach Considerations, Pharmacologic Therapy, Nerve Blocks, Ablative Procedures, and Brain Stimulation

  https://emedicine.medscape.com/article/1142459-treatment

  Pharmacologic management of cluster headache (CH) may be classified into 2 general approaches as follows: […] Abortive/symptomatic (eg, oxygen, triptans, ergot alkaloids, and anesthetics) […] Preventive/prophylactic (eg, calcium channel blockers, mood stabilizers, and anticonvulsants). […] Galcanezumab is the first drug to gain FDA approval for decreasing the frequency of episodic cluster headaches. […] Various procedures may be performed on trigeminal nerve or autonomic pathways, including alcohol injections and section or avulsion of nerves for chronic refractory cases. […] Surgical treatment may be initiated if the patient has contraindications to medications or if medications are not effective; it is employed only in strictly unilateral cases. […] Radiofrequency (RF) thermocoagulation of the trigeminal ganglion has had promising results in some patients with intractable pain.

• #30 Tips for Managing Cluster Headaches: Memphis Neurology: Neurology Specialists

  https://www.memphisneurology.com/blog/tips-for-managing-cluster-headaches

  Findings in the Journal of Headache Pain show that keeping a consistent sleep schedule regularizes the body’s circadian rhythms, which may help reduce the incidence of attacks. […] Exercise may well be a panacea for whatever ails you, and its benefits, either directly or indirectly, include relieving cluster headaches. […] Yoga combines effective breathing techniques with stretching, and it’s been linked with reducing cluster headaches. […] Tobacco has been linked with any number of severe health problems, including, as we’ve mentioned, chronic cluster headaches. […] Any form of alcohol can trigger a cluster attack. Abstaining, especially while in the throes of an attack, can help lessen the pain.

• #31 How to Get Rid of a Cluster Headache

  https://www.verywellhealth.com/cluster-headache-treatment-89239

  Although there is no known cure for cluster headaches, there are a number of natural treatments, over-the-counter (OTC) and prescription medications, and even surgical approaches that can help relieve symptoms. […] This article covers how to get rid of a cluster headache using natural treatments as well as OTC, prescription, and surgical treatment options. […] A growing body of research shows that keeping to a consistent sleep schedule can help reduce the frequency of cluster headaches. […] The benefits of exercise cannot be understated, and directly or indirectly, many have found it effective for cluster headaches. […] Among the many negative health effects of smoking cigarettes or using other tobacco products is that this habit has been linked with increases in chronic headache conditions.

• #31 How to Get Rid of a Cluster Headache

  https://www.verywellhealth.com/cluster-headache-treatment-89239

  This approach has been found to reduce the frequency of cluster attacks. […] Some studies have noted that mild electric shocks to the occipital lobes can also help. […] Another more novel treatment stimulation approach, deep brain stimulation involves targeting the hypothalamus region with electric signals to scramble pain processing at another of its sources. […] Oxygen therapy is the preferred treatment for cluster headaches during pregnancy, as it is both effective and risk-free.

• #32 Cluster headache – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080

  Cluster headache is rare. Treatments can shorten cluster headache attacks and lessen the pain. Also, medicines can reduce the number of cluster headaches. […] See a health care provider if you’ve just started to have cluster headaches. Your provider can rule out other illnesses and suggest treatment. […] There are several cluster headache triggers. The most common is drinking alcohol. Other triggers might include weather changes and certain medicines. […] Seek emergency care if you have any of these symptoms: A severe headache that comes on all of a sudden, often like a clap of thunder. A headache with a fever, nausea or vomiting, a stiff neck, confusion, seizures, numbness, or trouble speaking. These might point to a stroke, meningitis, encephalitis, a brain tumor or other problems.

• #33

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abk7653&lang=en-ca

  Triptans can be given as a shot, sprayed in the nose, or taken by mouth as a pill to reduce pressure and pain. […] Octreotide can be used as a shot to stop headache pain. […] Lidocaine is taken by nose drops to stop severe headache pain. […] Some medicines that prevent cluster headaches during a cluster period include: Suboccipital steroid injection. This medicine is used to reduce the number of headaches in a cluster cycle. […] Verapamil is commonly used for preventing both occasional and chronic cluster headaches. […] Lithium is often prescribed to prevent chronic cluster headaches. […] You must take these medicines every day during a cycle of headaches, even on days when you don’t get a headache.

• #34 Cluster Headache – UF Health

  https://ufhealth.org/conditions-and-treatments/cluster-headache

  Pain medicines and narcotics do not usually relieve cluster headache pain because they take too long to work. […] Surgical treatment may be recommended for you when all other treatments have failed. One such treatment is a neurostimulator. This device delivers tiny electrical signals to certain nerves such as the occipital nerve in the scalp. Your provider can tell you more about surgery. […] Avoid smoking, alcohol use, certain foods, and other things that trigger your headaches. A headache diary can help you identify your headache triggers. When you get a headache, write down the following: […] Day and time the pain began […] What you ate and drank over the past 24 hours […] How much you slept […] What you were doing and where you were right before the pain started

• #35 Treatment of Cluster Headache | MHNI Migraine Headache and Head Pain Treatment

  https://www.mhni.com/headache-pain-faq/cluster-headaches/treatment-cluster-headache

  Sphenopalatine ganglion (SPG) blockade is reported effective in some patients. […] Neurostimulation is the insertion of an active electrode near a nerve in the back of the head and neck area to stimulate a nerve, which in many cases turns off the pain. […] Various surgical procedures are available, the most popular of which is percutaneous SPG radiofrequency rhizotomy. […] Hospitalization for cluster headache patients may be essential during resistant or particularly severe episodes or when patients become desperate from recurring attacks.

• #36 Cluster Headache | Diagnosis & Treatment | UTHealth Houston

  https://med.uth.edu/neurosciences/conditions-and-treatments/face-pain-and-headache-clinic/cluster-headache/

  Treatment for cluster headache is focused on relief of symptoms through lifestyle changes to avoid headache triggers. Your doctor may prescribe medications such as triptans or corticosteroids to break the headache cycle, or dihydroergotamine injections that work by narrowing blood vessels around the brain and changing the blood flow patterns associated with a cluster headache attack. […] At UTHealth Houston Neurosciences, neurologists, neurosurgeons, neuro-oncologists, and radiation oncologists work together to determine the care each patient needs, discussing treatment options as a group. This approach saves our patients time and money and allows our specialists to share each others insights, leading to better treatment decision-making and outcomes. […] We first investigate options for nonsurgical treatment, including medical management, pain management, physical therapy, rehabilitation, and watchful waiting. When surgery is needed, our neurosurgeons routinely employ innovative minimally invasive techniques. Throughout the treatment process, our team works closely with the doctor who referred you to ensure a smooth transition back to your regular care plan. While you are with us, you can expect expert care, excellent communication, and genuine compassion.

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