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In 2004, the National Headache Foundation published Guidelines regarding treatment for cluster headache. The Guidelines include recommendations for treatment during a cluster period as well as maintenance between cluster periods. A brief summary of the Guidelines includes:

• During cluster period

  • oxygen
  • sumatriptan subcutaneous injection
  • sumatriptan nasal spray
  • zolmitriptan
  • dihydroergotamine
  • intranasal lidocaine

• Rapid suppression of attacks

  • corticosteroids
  • ergotamine derivatives
  • occipital nerve blockade

• Maintenance therapy

  • verapamil
  • methysergide maleate (not currently available in the US)
  • lithium
  • divalproex sodium
  • valproic acid
  • topiramate
  • melatonin

• Refractive (nonresponsive) cluster headaches

  • intravenous histamine desensitization - gradually increasing amounts of histamine phosphates are infused on the theory that a metabolic disturbance of histamines may play a role in cluster headaches. For some patients, this treatment restores responsiveness to drug therapy.

  • radiofrequency thermal neurolysis of the trigeminal nerve

  • glycerol injection
  • gamma knife radiosurgery

For more in-depth information about the NHF Guidelines for treatment of cluster headaches, please click on the following link:

http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=6582&nbr=4142