Cluster headache

NICE CG150: Headaches in over 12s BASH Guidelines

Initially, by subcutaneous injection, 6mg for 1 dose, followed by 6mg after at least 1 hour if required, to be taken only if headache recurs (patient not responding to initial dose should not take second dose for same attack). Max 12mg per day.

5mg, dose to administered as soon as possible after onset into one nostril only, followed by 5mg after at least 2 hours if required; maximum 10mg per day.

Prescribing Notes:

Oral medication is usually ineffective for acute attacks.
During a cluster headache, patients may suffer more than one attack daily and require up to 2 doses of sumatriptan in a 24 hour period.
In secondary care, patients may get rapid relief of the cluster headache by the use of oxygen. Patients should receive 100% oxygen at a flow rate of 10-12 litres/min. for 15 minutes.

History Notes

27/10/2022

East Region Formulary content agreed.

240mg-960mg daily in 3-4 divided doses.

Prescribing Notes:

Prophylaxis of cluster headache can be considered if the attacks are frequent, last for more than 3 weeks, or if the attacks cannot be treated effectively. Refer for specialist advice.
The position of specialist treatment in this pathway is not intended to guide place in therapy. The place in therapy is directed by a neurology specialist prescriber experienced in the management of the condition, use is in line with relevant local or national guidance.
Baseline ECG is necessary prior to initiating verapamil treatment and repeated with each dose escalation over 80mg twice daily.
Prophylaxis is indicated for 1-3 months during a cluster of attacks and should be withdrawn one month after headaches cease.
A short course of prednisolone may be appropriate as a bridging therapy while other prophylactic therapies are being initiated. Use is restricted, to selected cases and limited to no more than two courses per year in view of high adverse effect profile.

History Notes

27/10/2022

East Region Formulary content agreed.

Dose as per specialist and BNFc.

Prescribing Notes:

Cluster headache is very rare in children.
Oral medication is usually ineffective for acute attacks.
During a cluster headache, patients may suffer more than one attack daily and require up to 2 doses of sumatriptan in a 24-hour period.
In secondary care, patients may get rapid relief of the cluster headache by the use of oxygen. Patients should receive 100% oxygen at a flow rate of 10-12 litres/min. for 15 minutes.

History Notes

09/11/2023

East Region Formulary content agreed.