Cluster headache (CH): chronic drug prophylaxis

Evidence-based neurology checklist on cluster headache (ch): chronic drug prophylaxis: 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…

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

Topiramate

Civamide nasal spray

Ergotamine tartrate

Frovatriptan

Warfarin

Third-line medications

Insufficient evidenced treatments (Level U)

Other reported treatments

Probably ineffective treatments

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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