Cluster headache (CH): chronic drug prophylaxis

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Cluster headache (CH): chronic drug prophylaxis. This is the drug of choice. Fully referenced neurology checklist.

Verapamil

  • This is the drug of choice
  • The initial dose is at least 240mg daily (80mg tid)
  • The maintenance dose is usually 480mg: up to 960mg daily may be required
  • ECG is required at baseline, before dose increments, and 10 days after dose increments
  • Monitor blood pressure
  • Monitor ECG for bradycardia, arrhythmias, and heart block
  • The onset of cardiac side effects may be delayed by up to 2 years

Lithium

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Topiramate

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Civamide nasal spray

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Ergotamine tartrate

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Frovatriptan

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Warfarin

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Third-line medications

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Insufficient evidenced treatments (Level U)

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Other reported treatments

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Probably ineffective treatments

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References

  1. Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ. Treatment of cluster headache: The American Headache Society evidence-based guidelines. Headache 2016; 56:1093-1106. 
  2. Nesbitt AD, Goadsby PJ. Cluster headache. BMJ 2012; 344:e2407.
  3. May A, Leone M, Afra J, et al. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. Eur J Neurol 2006; 13:1066-1077.
  4. Ashkenazi A, Schwedt T. Cluster headache-acute and prophylactic therapy. Headache 2011; 51:272-286.
  5. Matharu M, Goadsby P. Cluster headache. Pract Neurol 2001; 1:42-49.
  6. And 8 more. Subscribe to see the full list

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