Cluster headache

Summary

Serotonin 5-HT1B/D agonists, collectively known as the triptans, are a firstline abortive treatment for cluster headache (CH). Long experience supports use of inhaled oxygen therapy for treatment of debilitating cluster attacks. The anecdotal evidence is complemented by a non-placebo controlled trial showing that inhaled oxygen is effective in CH. The somatostatin analog octreotide has been shown to inhibit vasopeptides released during CH episodes. Numerous ergot alkaloids have been used for treatment of CH. The only agent that has been recently studied is the inhaled form of the ergot derivative dihydroergotamine. Results from an uncontrolled, open-label study suggest a potential role for the atypical antipsychotic olanzapine in CH. NSAIDs are useful in some rare headache types that are similar to CH, but the current balance of evidence argues against utility of indomethacin or other NSAIDs in true CH. The use of opioids for CH is anecdotally reported for CH and variants.