What preventive treatment is effective for Cluster Headache

What preventive treatment is effective for Cluster Headache

Verapamil is the drug of choice for both episodic and chronic types. It is started at 120 to 240 mg a day and slowly increased (80-mg increase every 3 to 7 days as tolerated) to 480 mg if necessary.

High doses may be required (maximum dose 960 mg/day) depending upon tolerability and response. The drug can be given in both a regular formulation three times daily and an extended-release formulation once a day although, anecdotally, the three-times-daily dosing may be more effective.

With daily doses of 240 mg or higher, baseline and serial electrocardiograms, repeating the electrocardiograms 1 to 2 weeks after a dose change, usually in 80-mg increments, are indicated to monitor for the development of heart block, which becomes more frequent at higher doses. 

Topiramate may be effective (starting at 25 mg/day and titrating up to 100 mg/day). Valproic acid is questionably effective.

Melatonin is questionably helpful as a CH preventive. Lithium may be effective for chronic and episodic CHs typically starting at 300 mg bid or tid and increasing every 4 to 5 days based upon levels, with a typical maintenance dose of 900 to 1200 mg daily in three to four divided doses.

The lithium plasma level should be monitored and kept between 0.6 and 1.2 mmol/L.

Lithium has a narrow therapeutic window and numerous significant side effects.

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