Acute treatment of cluster headache attacks in adults

Cluster headaches are characterized by attacks of unilateral head pain and ipsilateral cranial autonomic cephalgias for 15 to 180 minutes in duration. Individual attacks typically recur from every other day to up to 8 times daily as episodes that may persist for weeks or months before spontaneous or treatment-induced remission. The treatment of cluster headache involves therapy for acute attacks and preventive interventions to reduce the frequency and duration of cluster headache episodes.

* Oral ergotamine or intravenous dihydroergotamine may be used as an alternative agent for patients who are unable to tolerate triptans and those with prior attacks that were refractory to triptans. However, ergots should not be given to patients who have received a triptan within the preceding 24 hours due to the risk of arterial vasoconstriction. Refer to UpToDate topic for additional details.

¶ Intranasal administration of triptans should be in a single nostril contralateral to the side of the cluster headache because patients frequently have rhinorrhea and nasal stuffiness ipsilateral to the headache.

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Acute treatment of cluster headache attacks in adults