Table 4.

Medications for cluster headache: Consider early specialist referral.

MEDICATION	DOSE
Acute
Subcutaneous sumatriptan	6 mg
Intranasal zolmitriptan	5 mg
100% oxygen	12 L/min for 15 min through non-rebreathing mask
Prophylactic*
First line
• verapamil	240–480 mg/d (higher doses might be required)
Second line
• lithium	900–1200 mg/d
Other
• topiramate	100–200 mg/d
• melatonin	Up to 10 mg/d

^*If the patient has more than 2 attacks daily, consider transitional therapy while verapamil is built up (eg, 60 mg of prednisone for 5 d, then reduced by 10 mg every 2 d until discontinued).

Adapted from Toward Optimized Practice.¹⁰