Treatment for Cluster Headache: European Academy of Neurology Guidelines

Acute cluster headache (CH), like migraine (MH) and tension type headache (TTH), is a primary headache, ie, there is no detectable underlying pathology to explain the headache.

CH is relatively rare and often disabling. Because it much less common than MH and TTH, CH may be misdiagnosed, especially as MH, although it has its own fairly unique symptoms. Treatment of CH is also different than for MH.

The European Academy of Neurology recently issued a new guide for the treatment of CH. As with treatment guidelines on other primary headache conditions, it divided its recommendations between treatments during the attack and preventive therapies. The following slides highlight the features of CH and the guideline recommendations for acute and preventive management.

Image credit all slides ©Chris Harvey/Shutterstock.com

Why "cluster?" An estimated 80% of people with CH only experience the headache and accompanying symptoms for set periods of time, most commonly 4-12 weeks.

Symptoms of cluster headache

Acute treatment for cluster headache: Oxygen

Acute treatment for cluster headache: Triptan medications

Acute treatment for cluster headache: Ergot alkaloids

Acute treatment for cluster headache: calcitonin gene-related peptide inhibitors

Preventive treatment for cluster headache: verapamil, lithium

Preventive treatment for cluster headache: corticosteroids, topiramate, melatonin

Nonpharmacologic treatment for cluster headache: Noninvasive vagus nerve stimulation, greater occipital nerve block; invasive neuromodulation: sphenopalatine ganglion stimulation, occipital nerve stimulation, deep brain stimulation

Last resort treatment for cluster headache: anesthetics, glycerol injected into specific brain areas

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Source: May A, Evers S, Goadsby PJ, et al. European Academy of Neurology guidelines on the treatment of cluster headache. Eur J Neurol. 2023.30:2955-2979. doi:10.1111/ene.15956

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