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Cluster headache: Treatment and prognosis

Arne May, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Cluster headache belongs to a group of idiopathic headache entities, the trigeminal autonomic cephalalgias (TACs), all of which involve unilateral, often severe headache attacks and typical accompanying autonomic symptoms [1]. The concept of the TACs is useful for clinicians seeking a pathophysiologic understanding of the primary neurovascular headaches and a rational therapeutic approach to treating or preventing these headaches. Despite the diagnostic challenges, the short-lasting primary headaches are important to recognize because of their excellent but highly selective response to therapy.

Currently, the treatment of cluster headache is based on empirical data rather than a clear understanding of the biologic mechanisms that underlie the disease [2,3]. Drug treatment in cluster headache shows a placebo rate of about 30 percent, similar to that observed in migraine treatment [4]. In general, cluster headache treatment can be divided into acute therapy aimed at aborting individual attacks and prophylactic therapy aimed at preventing recurrent attacks during the cluster period [5].

This topic will review the acute treatment, prevention, and prognosis of cluster headache. Other aspects of cluster headache are discussed separately. (See "Cluster headache: Epidemiology, clinical features, and diagnosis".)


Subcutaneous sumatriptan and oxygen inhalation are first-line treatments for acute cluster headache attack [6]. Other agents with some evidence of effectiveness include ergots, lidocaine, and octreotide.

Oxygen — Although controlled trial evidence is limited [7], oxygen therapy is considered to be safe and effective for aborting cluster headache.


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Literature review current through: Sep 2016. | This topic last updated: Jun 13, 2016.
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