Medications for cluster headache: Consider early specialist referral.
| MEDICATION | DOSE |
|---|---|
| Acute | |
| Subcutaneous sumatriptan | 6 mg |
| Intranasal zolmitriptan | 5 mg |
| 100% oxygen | 12 L/min for 15 min through non-rebreathing mask |
| Prophylactic* | |
| First line | |
| • verapamil | 240–480 mg/d (higher doses might be required) |
| Second line | |
| • lithium | 900–1200 mg/d |
| Other | |
| • topiramate | 100–200 mg/d |
| • melatonin | Up to 10 mg/d |
↵* If the patient has more than 2 attacks daily, consider transitional therapy while verapamil is built up (eg, 60 mg of prednisone for 5 d, then reduced by 10 mg every 2 d until discontinued).
Adapted from Toward Optimized Practice.10