Preventive treatment to suppress cluster headache episodes 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 prevention to reduce the frequency and duration of cluster headache episodes.

* Specific glucocorticoid dose and tapering regimens may vary according to individual cluster episode patterns. For patients unable to take glucocorticoids due to risk of adverse effects such as hyperglycemia or hypertension, verapamil or other alternative preventive agents may be given alone. Refer to UpToDate topic for additional details.

¶ An electrocardiogram may be obtained at baseline and should be obtained after each dose increment above a total daily dose of 480 mg to assess for cardiac arrhythmias.

Δ For patients with partial response to verapamil, additional alternative therapy may provide adjunctive benefit. Alternative preventive therapies are used alone or in combination for other patients who do not respond or have a contraindication to verapamil. Refer to UpToDate topic for additional details.

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Preventive treatment to suppress cluster headache episodes in adults