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Migraine in Primary Care Advisors


Treatment guidelines for cluster headache


Goals of therapy

Prevent the occurrence of the headaches, while effectively and rapidly treating attacks that occur and reducing their impact on the patient’s daily activities.

First-line treatments

Follow up

Therapy is required for the duration of the cluster periods, as they occur. Lithium is a suitable prophylactic agent for when verapamil fails, while nasal spray triptans or inhalation of high flow-rate (10 L/min) oxygen via a mask can be used as alternative acute medications. Diving masks can be obtained from specialist retailers, or on loan from the Migraine Action Association – or the Organisation for the Understanding of Cluster Headache (OUCH) –

When to refer

The GP who is experienced in headache management should be able to successfully manage most patients with cluster headaches. However, referral to specialist neurology or headache services may be necessary when:

The GP who is not so experienced in headache management may wish to refer all their patients who have cluster headache.


Dowson AJ, Bradford S, Lipscombe S et al. Managing chronic headaches in the clinic. Int J Clin Pract 2004; in press.


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