Selecting a Treatment Regimen Cluster Headache – Treatment Acute Treatments
Intranasal zolmitriptan 5 and 10 mg 100% oxygen
Subcutaneous sumatriptan 6 mg Level A
Intranasal cocaine hydrochloride 10% Intranasal lidocaine 10%
Oral zolmitriptan 5 and 10 mg Level C
Intranasal sumatriptan 20 mg Level B Subcutaneous octreotide 100 mcg Transitional Treatments
> 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)
> Suboccipital steroid injections
> Ergotamine tartrate 1 or 2 mg given once daily or in divided doses
Preventive Treatments
Suboccipital steroid/local anesthetic injection
Intranasal civamide (100 microL 0.025%)
Level B
Melatonin 10 mg daily Verapamil 360 mg daily Lithium 900 mg daily
Level C
2
