What is the acute and transitional treatment for Cluster Headache
Triptans, especially subcutaneous sumatriptan 4 to 6 mg, are the mainstay of treatment.
Subcutaneous sumatriptan can result in pain freedom within 20 minutes in 75% of CH suffers. Intranasal zolmitriptan 5 mg and sumatriptan 20 mg may be effective but less so than subcutaneous sumatriptan.
Anecdotally, some patients report benefit from oral triptans. Dihydroergotamine 1 mg IM or 2 mg intranasally may also be effective. Inhalation of 100% oxygen administered through a nonrebreather face mask at a rate of 8 to 15 L/min for 15 to 20 minutes with the patient sitting upright is effective in about 80% of cases.
Some patients with episodic and chronic CH benefit from transitional or bridging therapy resulting in a temporary remission while waiting for either a preventive medication to work or for the bout to end.
One regimen anecdotally suggested is prednisone 60 mg daily for 5 days and then tapered by 10 mg daily. Ipsilateral greater occipital nerve block with steroid and local anesthetic has also been reported as effective.
