HEADACHE-CLUSTER HEADACHE MANAGEMENT

SUMMARY

1. Treatment: The best acute treatment is oxygen. Inhalation of oxygen at 6 Lim in x 15 minutes is commonly rapidly abortive, acting to inhibit neuronal activation in the trigeminocervical complex.

2. Subcutaneous and intranasal triptans are effective and can be combined with oxygen; but remember, the triptans should not be used in patients with a history of or strong risk factors for CHD and stroke.

3. Verapamil is the drug of choice for prophylaxis (outpatient oral titration up to 480 mg), but monitor the patient's pulse and ECG
for bradycardia and heart block when titrating higher than 240 mg.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].