Selecting a Treatment Regimen
Cluster Headache – Treatment
Level A
Subcutaneous sumatriptan 6 mg
Intranasal zolmitriptan 5 and 10 mg
100% oxygen
Acute Treatments
Level B
Intranasal sumatriptan 20 mg
Oral zolmitriptan 5 and 10 mg
Level C
Intranasal cocaine hydrochloride 10%
Intranasal lidocaine 10%
Subcutaneous octreotide 100 mcg
Level B
Intranasal civamide
(100 microL 0.025%)
Suboccipital steroid/local anesthetic
injection
Preventive Treatments
Level C
Melatonin 10 mg daily
Verapamil 360 mg daily
Lithium 900 mg daily
> Steroids (oral prednisone 60 mg daily for 3 days, then
decreased by 10 mg every 3 days for a total of 18 days)
> Dihydroergotamine (1 mg subcutaneous/
intramuscular twice a day for several days)
> Ergotamine tartrate 1 or 2 mg given once daily or
in divided doses
> Suboccipital steroid injections
Transitional Treatments
