Abortive Therapy for Cluster Headache

The goal of abortive therapy for cluster headache is fast, effective and consistent relief. Because a cluster headache is relatively short in duration, the abortives should work within 10-15 minutes to be considered adequate therapy.

Oxygen *

  • Excellent abortive for cluster
  • Shown to work in up to 70% of cluster patients
  • Safe and easy to use
  • Typical dosing — 100% oxygen given via face mask (nasal cannula not effective) at 7-10 liters/minute for 20 minutes. Pain relief typically occurs after 10-20 minutes

*  Can be used daily

Sumatriptan **

  • Has been effective in cluster headache. A doctor must be consulted before use
  • Injectable form — most effective, often giving complete relief within 15 minutes after injection
  • Nasal spray formulation is not as effective as injectable
  • Oral tablets are not effective in cluster due to the 1-2 hours it takes for the medication to produce relief; the individual cluster headache is over by then

** Because triptans are not appropriate for daily use and certainly not multiple times each day, this treatment must be reserved for only the most serious attacks

Dihydroergotamine (DHE) ***

  • Available in injectable and nasal spray preparations
  • Most cluster patients experience relief within 15 minutes when DHE is given intravenously; relief is slower with intramuscular or subcutaneous formulations

*** Can be used for several days in a row but not endlessly