Acute treatment for cluster headache
A subcutaneous triptan is the most effective treatment for cluster headache. Some patients respond to intranasal sumatriptan or oral rizatriptan or zolmitriptan. Use:
1 sumatriptan 6 mg subcutaneously headache, cluster sumatriptan
OR
2 sumatriptan 20 mg intranasally sumatriptan
OR
3 rizatriptan 10 mg orally headache, cluster rizatriptan
OR
4 zolmitriptan 2.5 mg orally. headache, cluster zolmitriptan
Patients with cluster headache can also get relief from using high flow oxygen. In an emergency, consider using oxygen as well as subcutaneous treatment with a triptan.
For high flow oxygen, use:
oxygen 100% 15 L/minute by inhalation via a tight-fitting nonrebreathing mask, for 15 to 20 minutes, then stop. headache, cluster
If effective, oxygen can be used at home. However, to get an appropriate cylinder and regulator, the patient needs a letter of authorisation from the treating physician to a medical gas supplier.
For severe refractory cluster headache, indometacin or dihydroergotamine (if the patient has not had a triptan in the preceding 24 hours) can be used.
Do not give a triptan for 24 hours after dihydroergotamine therapy.
A greater occipital nerve block, as used for bridging treatment, can be used as acute treatment in some patients (see advice).