Table 13.

Levels of recommendation for symptomatic (a) and preventive (b) treatment of cluster headache

Drug	Dosage	Level of recommendation	Comments
(a) Symptomatic treatments
Sumatriptan	6 mg s.c	I
Sumatriptan	20 mg nasal spray	II	It is not approved by regulatory agency for cluster headache in Italy
Zolmitriptan	5–10 mg nasal spray	II	It is approved by regulatory agency for cluster headache in Italy
Oxygen inhalation	6–15 l/min for 15 min	I

Drug	Dosage	Level of recommendation		Comments
		Episodic	Chronic
(b) Preventive treatments for episodic and chronic cluster headache
Verapamil	80–120 mg × 3 per day per os	I	IIIa	It is not approved by regulatory agency for cluster headache in Italy
Prednisone	50–75 mg/day per os for 3–7 days then gradually decreased to stop within 10 days	II	IIIb	It is not approved by regulatory agency for cluster headache in Italy Repeated use may, over time, induce severe adverse events
Pizotifen	Start with the dosage of 1 mg/day per os, increase the dosage to a maximum of 2.5 mg, to be reached in 2 weeks	IIIa	–
Intranasal capsaicin	300 μg/day in the ipsilateral nostril repeatedly to obtain a complete desensitization	IIIa	IIIa	It is not available in Italy
Methysergide	Start with the dosage of 2 mg/day per os in three administrations, gradually increase the dosage (every 3–7 days) to the dosage of 8 mg/day. Maximum 6 month treatment	IIIb	IIIb	It is not available in Italy
Histamine sulphate	i.v. diluted in saline or 5 %: 1st day: 2.75 mg in 250 ml, 2nd to 10th day: 11 mg in 500 cc Starting flow rate of 10 ml/h, then 120 ml/h	–	IIIa	It is not available in Italy
Lithium carbonate	300 mg × 3 per day for no more than 22 weeks	–	IIIb

Drugs with levels of recommendation IV include serotonin antagonists, ergotamine derivatives, triptans and melatonin