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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".)


Acute therapy is useful for aborting individual attacks of cluster headache, but does not reduce the duration of the cluster headache bout (ie, the period of recurrent attacks) [6]. Therefore, preventive therapy should be started without delay once a cluster headache bout begins.

Acute headache treatment — For patients with acute cluster headache, we recommend initial treatment with either 100 percent oxygen or a triptan, in agreement with national guidelines and expert consensus [6,7]. Oxygen should be tried first if available (eg, in a hospital or emergency clinic setting) since it is without side effects. Otherwise, subcutaneous sumatriptan 6 mg can be used as initial therapy. (See 'Oxygen' below and 'Triptans' below.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 15, 2017.
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