Treatment of cluster headaches - Recommendations of the Deutsche Migrane- und Kopfschmerz-Gesellschaft

Cluster headache is characterised by severe unilateral headache attacks lasting 15 to 180 minutes. The frequency of attacks varies between 1 attack every other day and 8 attacks per day. At least one of the following accompanying symptoms is present ipsilaterally: conjunctival injection, nasal congestion, lacrimation, rhinorrhea, increased facial sweating, miosis, ptosis or lid edema. Cluster headache is presumed to be caused by an aseptic inflammatory process in the cavernous sinus and the superior ophthalmic vein. Inhalation of 100% oxygen is considered first choice in the treatment of the acute cluster attack. Sumatriptan s.c. is an effective pharmacological alternative. Choice of prophylactic drug depends on whether the cluster headache is episodic or chronic. Verapamil, ergotamin, methysergide, steroids, lithium and valproic acid may be used in episodic cluster headache. In chronic: cluster headache drugs of first choice are verapamil and lithium.