{ "schemaVersion": 2, "eyebrow": "Headache Medicine", "title": "Cluster Headache", "summary": "Recognize the cluster phenotype promptly, exclude a structural trigeminal autonomic cephalalgia mimic with neuroimaging, abort attacks with oxygen or a triptan, and rapidly add transitional and preventive therapy to suppress recurrent attacks during an active bout.", "seoDescription": "Physician guide to diagnosing cluster headache, excluding secondary mimics, treating acute attacks, and selecting transitional and preventive therapy.", "clinicalQuestion": "How should physicians confirm cluster headache, exclude secondary causes, and treat attacks and active bouts?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "cluster headache", "trigeminal autonomic cephalalgia", "high-flow oxygen", "sumatriptan", "verapamil", "galcanezumab", "secondary headache" ], "keyTakeaways": [ "Obtain neuroimaging for every trigeminal autonomic cephalalgia or TAC-like presentation because structural lesions can produce an indistinguishable syndrome. [1]", "Treat an acute attack with 100% oxygen at at least 12 L/min through a non-rebreathing mask with reservoir bag and/or a subcutaneous or nasal triptan. [6][23]", "Use a three-track plan during a bout: rapid abortive treatment for each attack, transitional suppression while preventive therapy begins, and a maintenance preventive strategy for recurrent attacks. [14][15]", "Verapamil is the principal medium- to long-term preventive option; lithium, topiramate, melatonin, and neuromodulation are alternatives for selected refractory presentations. [14]", "Galcanezumab is FDA-approved for episodic cluster headache, whereas randomized anti-CGRP monoclonal antibody trials have not met endpoints in chronic cluster headache. [16]" ], "sections": [ { "id": "recognition-and-urgent-exclusions", "eyebrow": "First Encounter", "heading": "Confirm the phenotype while screening for secondary danger", "intro": "Treat the syndrome as a TAC until the phenotype and imaging support a primary diagnosis.", "paragraphs": [ "A cluster phenotype requires recurrent severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 minutes when untreated. Attacks may occur from one every other day to eight per day; a typical bout consists of recurrent attacks over weeks to months. Cranial autonomic features supporting the diagnosis include conjunctival injection or lacrimation, nasal congestion or rhinorrhea, and eyelid swelling. [21][23][24]", "Do not regard a convincing autonomic phenotype as sufficient to exclude secondary disease. Structural lesions can cause trigeminal autonomic cephalalgias and TAC-like syndromes; obtain neuroimaging in all patients with a TAC or TAC-like presentation. For a first cluster bout, discuss neuroimaging with a headache-experienced clinician or neurologist. [1][23]", "Escalate urgently when the painful eye is red and visual symptoms include misty vision or halos: acute narrow-angle glaucoma is a key mimic and is suggested by a semidilated pupil, whereas cluster headache is associated with miosis. A suspected serious secondary headache or red-flag presentation warrants specialist admission or referral rather than outpatient cluster-directed treatment alone. [19][23]" ], "bullets": [ "Document attack duration, maximum daily frequency, laterality, autonomic signs, and whether attacks recur in a circumscribed bout; these features distinguish the cluster pattern from less stereotyped unilateral headache syndromes. [21][23][24]", "Classify chronic disease when attacks occur from once every other day to eight daily and pain-free periods are less than 1 month during a 12-month period. [23]", "Arrange specialist assessment when the diagnosis is uncertain, the first bout requires imaging planning, red flags are present, or attacks persist despite acute and preventive treatment. [19][20][23]" ], "subsections": [], "table": { "caption": "High-yield phenotype and urgent mimic discriminators. [21][23][24]", "columns": [ "Clinical branch", "Finding", "Next action" ], "rows": [ [ "Cluster phenotype", "Severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes untreated, with recurrent attacks from every other day to eight daily. [21][23]", "Initiate attack treatment immediately and begin bout-level management. [14][23]" ], [ "Autonomic support", "Conjunctival injection/lacrimation, nasal congestion/rhinorrhea, or eyelid swelling on the pain side. [24]", "Increase confidence in a TAC phenotype but still obtain neuroimaging. [1]" ], [ "Acute eye emergency", "Painful red eye with misty vision or halos and a semidilated pupil. [23]", "Evaluate urgently for acute narrow-angle glaucoma. [23]" ], [ "Secondary TAC concern", "Any TAC or TAC-like syndrome, including an otherwise typical presentation. [1]", "Obtain neuroimaging to exclude a structural lesion. [1]" ] ] } }, { "id": "acute-attack-treatment", "eyebrow": "Abortive Care", "heading": "Stop each attack with oxygen or a rapid-onset triptan", "intro": "Choose therapies that can act within the 15-180-minute attack window.", "paragraphs": [ "Prescribe 100% oxygen at a flow of at least 12 L/min by non-rebreathing mask with reservoir bag for acute attacks. Arrange both home and ambulatory oxygen so the patient can treat attacks at onset rather than depend on emergency care. The European Academy of Neurology gives a strong recommendation for 100% oxygen at at least 12 L/min for 15 minutes. [6][23]", "Use subcutaneous sumatriptan or a nasal triptan when oxygen is unavailable, inadequate, impractical, or when the patient needs a pharmacologic abortive option. American Headache Society guidance identifies subcutaneous sumatriptan, zolmitriptan nasal spray, and high-flow oxygen as established acute treatments; NICE similarly recommends oxygen and/or a subcutaneous or nasal triptan. [9][23]", "Do not select slow oral rescue strategies as the primary attack plan when attacks are brief and rapidly escalating. Other acute options discussed in reviews include octreotide, lidocaine, ergotamine, and dihydroergotamine, but injectable sumatriptan and inhaled oxygen are viewed as first-line therapies. [4]" ], "bullets": [ "Oxygen prescription specification: 100% oxygen, at least 12 L/min, non-rebreathing mask, and reservoir bag. [23]", "Home management specification: arrange home and ambulatory oxygen rather than providing only an in-clinic treatment recommendation. [23]", "Acute medication options supported by guideline-level recommendations: subcutaneous sumatriptan or nasal zolmitriptan; use a nasal triptan where a noninjectable route is needed. [9][23]" ], "subsections": [], "table": { "caption": "Acute treatment selection for a recognized cluster attack. [6][9][23]", "columns": [ "Option", "How to use", "Role in the attack plan" ], "rows": [ [ "High-flow oxygen", "100% oxygen at at least 12 L/min for 15 minutes through a non-rebreathing mask with reservoir bag. [6][23]", "First-line acute treatment; prescribe home and ambulatory access. [9][23]" ], [ "Subcutaneous sumatriptan", "Use as an acute triptan option for cluster attacks. [9][23]", "First-line pharmacologic abortive therapy, alone or alongside oxygen. [9][23]" ], [ "Zolmitriptan nasal spray", "Use as a nasal triptan acute option. [9]", "Alternative when a noninjectable triptan route is preferred. [9][23]" ], [ "Other reviewed rescue options", "Octreotide, lidocaine, ergotamine, or dihydroergotamine. [4]", "Consider only within an individualized plan when first-line options are unsuitable or inadequate. [4]" ] ] } }, { "id": "bout-suppression-and-prevention", "eyebrow": "Bout Management", "heading": "Add transitional suppression and a preventive regimen early", "intro": "Frequent daily attacks require preventive treatment in parallel with acute abortive therapy.", "paragraphs": [ "Separate treatment into acute, transitional, and maintenance phases. Acute therapy terminates individual attacks; transitional therapy is used to reduce attack frequency while a maintenance preventive takes effect; the maintenance goal is sustained suppression of further attacks. [14][15]", "For interim suppression during an active bout, use a short course of high-dose oral corticosteroids or consider a local anesthetic/corticosteroid injection around the greater occipital nerve on the pain side. These strategies are specifically described as interim preventives to reduce attack frequency. [14]", "Use verapamil as the main medium- to long-term preventive option. When verapamil is not tolerated, ineffective, or insufficient, alternatives discussed for preventive treatment include lithium, topiramate, melatonin, baclofen, valproic acid, and botulinum-based approaches; evidence and selection vary across these options. [4][14]", "For episodic cluster headache, galcanezumab is FDA-approved. This distinction matters: randomized anti-CGRP monoclonal antibody trials have not met prevention endpoints in chronic cluster headache, so do not extrapolate the episodic approval to chronic disease as an established effective strategy. [16]", "Refer drug-resistant chronic cluster headache to a headache center capable of neuromodulation assessment. Hypothalamic stimulation has been reported effective in many patients with chronic, several-times-daily attacks refractory to medication, and occipital nerve neurostimulation has shown promise in chronic drug-resistant disease. [5]" ], "bullets": [ "Active episodic bout with high attack burden: pair a transition strategy, such as high-dose oral corticosteroids or ipsilateral greater occipital nerve injection, with a maintenance preventive. [14]", "Medium- or long-term prevention: start with verapamil; consider lithium, topiramate, or melatonin when the clinical context requires an alternative. [14]", "Episodic disease: galcanezumab is an FDA-approved preventive option. [16]", "Chronic medication-refractory disease: consider referral for noninvasive or invasive neuromodulation rather than repeated empiric acute-treatment changes. [5][14]" ], "subsections": [ { "heading": "Preventive treatment by clinical pattern", "paragraphs": [ "Episodic disease generally occurs in daily attack bouts lasting 6-12 weeks followed by remission periods, making transitional therapy particularly useful when a bout begins and while a longer-term preventive is being established. [5]", "Chronic disease has no continuous pain-free interval of at least 1 month over 12 months. In this group, persistent high-frequency attacks and failure of pharmacologic prevention should trigger consideration of neuromodulation pathways; chronic anti-CGRP monoclonal antibody trial results have not established efficacy. [5][16][23]" ], "bullets": [] } ], "table": { "caption": "Three-phase treatment structure for cluster headache. [14][15][16]", "columns": [ "Treatment phase", "Clinical objective", "Supported options" ], "rows": [ [ "Acute", "Terminate an individual attack. [14][15]", "100% oxygen at at least 12 L/min by non-rebreathing mask; subcutaneous sumatriptan; nasal triptan. [6][9][23]" ], [ "Transitional", "Reduce attacks while maintenance prevention is initiated. [14][15]", "Short high-dose oral corticosteroid course or ipsilateral greater occipital nerve local anesthetic/corticosteroid injection. [14]" ], [ "Maintenance", "Suppress subsequent attacks during a bout or chronic disease. [14][15]", "Verapamil; alternatives include lithium, topiramate, and melatonin. [14]" ], [ "Episodic disease option", "Prevent attacks in FDA-approved episodic cluster headache use. [16]", "Galcanezumab. [16]" ], [ "Refractory chronic disease", "Address persistent medication-resistant, high-frequency attacks. [5][14]", "Specialty neuromodulation assessment, including noninvasive or invasive approaches. [5][14]" ] ] } }, { "id": "follow-up-and-escalation", "eyebrow": "Follow-up", "heading": "Measure attack burden and escalate when the phenotype or response changes", "intro": "Follow-up should determine whether the initial diagnosis and treatment phase remain correct.", "paragraphs": [ "At follow-up, record attacks per day, time to treatment, attack duration, response to oxygen, response to triptan, and emergence of a pain-free interval. This distinguishes an episodic bout entering remission from chronic disease, defined by pain-free periods shorter than 1 month over 12 months. [23]", "Reassess the diagnostic branch when the clinical pattern changes, new neurologic or ocular findings emerge, or treatment response becomes discordant with the established syndrome. Because structural lesions can present as TACs or TAC-like syndromes, an atypical or evolving course should not be managed as uncomplicated primary cluster headache without imaging review. [1]", "Refer early for specialist-directed preventive selection when attacks remain frequent despite a complete acute plan, when corticosteroid transition or greater occipital nerve injection is being considered, and when medication-refractory chronic disease raises neuromodulation candidacy. [5][14][19]" ], "bullets": [ "Use a headache diary to establish attack frequency against the cluster range of one every other day to eight daily. [23]", "Treat a new painful red eye with visual haze or halos as an ocular emergency pathway, not as failure of cluster therapy. [23]", "Revisit neuroimaging when a TAC-like syndrome is atypical or changes over time. [1]" ], "subsections": [], "table": { "caption": "Follow-up decisions based on attack pattern and response. [1][5][14][23]", "columns": [ "Follow-up finding", "Interpretation", "Action" ], "rows": [ [ "Attacks decline and a sustained pain-free interval develops", "Compatible with episodic-bout remission. [5][23]", "Reassess ongoing preventive need and retain an acute treatment plan for future attacks. [14]" ], [ "Pain-free periods remain less than 1 month over 12 months", "Meets the chronic cluster headache definition. [23]", "Optimize preventive therapy and consider specialty neuromodulation assessment if medication resistant. [5][14]" ], [ "Atypical, evolving, or TAC-like presentation", "Structural disease remains a concern. [1]", "Obtain or review neuroimaging and involve a headache specialist or neurologist. [1][19]" ], [ "Painful red eye with misty vision or halos", "Possible acute narrow-angle glaucoma. [23]", "Urgent ocular evaluation. [23]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Trigeminal Autonomic Cephalgias Due to Structural Lesions", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/articlepdf/793093/nnr60007_25_31.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "A Positron Emission Tomographic Study in Spontaneous ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/fullarticle/789108", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Effect of Infusion of Calcitonin Gene-Related Peptide on Cluster ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/NEUR/articlepdf/2687227/jamaneurology_vollesen_2018_oi_180042.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 4, "title": "Acute and Preventive Treatments for Cluster Headache | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/acute-preventive-treatments-cluster-headache-JN201105100000004", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 5, "title": "Cluster headache: pharmacological treatment and neurostimulation | Nature Reviews Neurology", "detail": "www.nature.com", "url": "https://www.nature.com/articles/ncpneuro1050", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 6, "title": "European Academy of Neurology guidelines on the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.15956", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 7, "title": "Biomarkers in cluster headache: A systematic review - Søborg", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.14641", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com" }, { "number": 8, "title": "Overview and Research Trends on Cluster Headache ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/ane/5110463", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 9, "title": "Treatment of Cluster Headache: The American Headache ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/head.12866", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com" }, { "number": 10, "title": "Quality Improvement in Neurology: Headache Quality ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13988", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com" }, { "number": 11, "title": "European Academy of Neurology guideline on the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/ene.14268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 12, "title": "15. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Trigeminal Autonomic Cephalgias Due to Structural Lesions", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/articlepdf/793093/nnr60007_25_31.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by I Favier · 2007 · Cited by 186 — Trigeminal autonomic cephalgias (TACs) include cluster headache, We recommend neuroimaging in all patients with a TAC or TAC-like syndrome. al relief of", "score": 0.41705835 }, { "number": 2, "title": "A Positron Emission Tomographic Study in Spontaneous ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/fullarticle/789108", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by SK Afridi · 2005 · Cited by 548 — Neuroimaging studies have contributed significantly to the understanding of primary headaches, such as migraine and cluster headache.4", "score": 0.32546747 }, { "number": 3, "title": "Effect of Infusion of Calcitonin Gene-Related Peptide on Cluster ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/NEUR/articlepdf/2687227/jamaneurology_vollesen_2018_oi_180042.pdf", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Headache intensity scores are presented as medians and time to onset of cluster headache–like attacks, and autonomic symp- toms after CGRP infusion are", "score": 0.17063265 }, { "number": 4, "title": "Acute and Preventive Treatments for Cluster Headache | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/acute-preventive-treatments-cluster-headache-JN201105100000004", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "Title: Acute and Preventive Treatments for Cluster Headache | NEJM Clinician\nAcute and Preventive Treatments for Cluster Headache | NEJM Clinician. # Acute and Preventive Treatments for Cluster Headache. Tamara Pringsheim, MD, FRCPC (Neurology). Tamara Pringsheim, MD, FRCPC (Neurology). Tamara Pring", "score": 0.7653308 }, { "number": 5, "title": "Cluster headache: pharmacological treatment and neurostimulation | Nature Reviews Neurology", "detail": "www.nature.com", "url": "https://www.nature.com/articles/ncpneuro1050", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Title: Cluster headache: pharmacological treatment and neurostimulation | Nature Reviews Neurology\n# Cluster headache: pharmacological treatment and neurostimulation. In episodic cluster headache, attacks usually occur daily in 6–12-week bouts (cluster periods) followed by remission periods. This Re", "score": 0.7251239 }, { "number": 6, "title": "European Academy of Neurology guidelines on the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.15956", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by A May · 2023 · Cited by 110 — For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15", "score": 0.7325349 }, { "number": 7, "title": "Biomarkers in cluster headache: A systematic review - Søborg", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.14641", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "by MLK Søborg · 2024 · Cited by 21 — Cluster headache is a condition with extensive clinical challenges in terms of diagnosis and treatment. Several of the diagnosis and incorrect", "score": 0.55623144 }, { "number": 8, "title": "Overview and Research Trends on Cluster Headache ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1155/ane/5110463", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "The study also delves into the treatment phases and guidelines for cluster headaches, emphasizing the need for evidence-based and", "score": 0.47343868 }, { "number": 9, "title": "Treatment of Cluster Headache: The American Headache ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/head.12866", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "by MS Robbins · 2016 · Cited by 343 — Results and Recommendations. For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments", "score": 0.4501424 }, { "number": 10, "title": "Quality Improvement in Neurology: Headache Quality ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13988", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "Sep 23, 2020 — American Headache Society systematic review and evidence-based guideline. Headache 2020; 60: 318–336.", "score": 0.42749292 }, { "number": 11, "title": "European Academy of Neurology guideline on the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/ene.14268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Fremanezumab significantly reduced the frequency of headache days of at least moderate severity by −4.7 days (P < 0.0001) and −5.2 days (P <", "score": 0.418341 }, { "number": 12, "title": "15. Cluster Headache - Lansbergen - 2025 - Pain Practice", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/papr.70050", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by CS Lansbergen · 2025 · Cited by 5 — Cluster headache is a rare primary headache disorder characterized by excruciating unilateral pain around the eye, lasting between 15 and 180", "score": 0.3691564 }, { "number": 13, "title": "Clinical Characteristics and Treatment Patterns Among ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13127", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "Objective To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH).", "score": 0.35528317 }, { "number": 14, "title": "World neurology updates: Other primary headache disorder – Treatment", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S240565022400042X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "•Triptans, such as sumatriptan by injection, high flow 100% oxygen by face mask, or non-invasive vagus nerve stimulation, are mainstay acute treatments of attacks of cluster headache. \n •Interim preventive treatments to reduce attack frequency include a short course of high dose oral corticosteroi", "score": 0.8018276 }, { "number": 15, "title": "Diagnostic protocols and newer treatment modalities for cluster headache - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0011502921001929", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Diagnostic protocols and newer treatment modalities for cluster headache - ScienceDirect\n# Diagnostic protocols and newer treatment modalities for cluster headache. Moreover, Cluster Headache has an exhaustive list of options for both Preventive and Abortive treatment. This article focuses on", "score": 0.76279575 }, { "number": 16, "title": "Long-term safety, tolerability, and efficacy of eptinezumab in chronic cluster headache (CHRONICLE): an open-label safety trial", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1474442225000651", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Calcitonin gene-related peptide (CGRP) has been shown to be elevated during acute attacks of spontaneous 13 and nitroglycerin-triggered 14 cluster headache, whereas the infusion of CGRP triggers attacks in both episodic cluster headache and chronic cluster headache.15 Moreover, CGRP levels are assoc", "score": 0.6836946 }, { "number": 17, "title": "Effectiveness of anti-CGRP monoclonal antibodies in the preventive treatment of migraine: A prospective study of 63 patients - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2387020623001225", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Effectiveness of anti-CGRP monoclonal antibodies in the preventive treatment of migraine: A prospective study of 63 patients - ScienceDirect\n# Original article Effectiveness of anti-CGRP monoclonal antibodies in the preventive treatment of migraine: A prospective study of 63 patientsEfectivid", "score": 0.65940565 }, { "number": 18, "title": "Headaches: scope consultation", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg150/documents/headaches-scope-consultation-table2", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "should probably be placed in diagnosis section and not non pharmacological management Note: Oxygen seems to have moved from 4.3.1 (d) to 4.3.1 (e) which should be (f) to be consistent with scoping document. pharmacological treatment wording. There is some evidence to suggest that imaging can reduce ", "score": 0.48996773 }, { "number": 19, "title": "Headache - cluster | Health topics A to Z | CKS - NICE", "detail": "cks.nice.org.uk", "url": "https://cks.nice.org.uk/topics/headache-cluster", "authors": "cks.nice.org.uk", "host": "cks.nice.org.uk", "snippet": "Differential diagnosis ... Arranging specialist admission or referral if there are any red flags or a serious underlying cause of secondary headache is suspected.", "score": 0.48250288 }, { "number": 20, "title": "NATIONAL INSTITUTE FOR HEALTH AND CARE ...", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/htg408/documents/overview", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "of the cervical branch of the vagus nerve for cluster headache and migraine Page 27 of 29 1.4 Further research studies should clearly define patient selection and report the intensity and duration of stimulation, medication use and quality of life, in addition to documenting the effects on headache ", "score": 0.46978843 }, { "number": 21, "title": "assessment: Scenario: Headache - diagnosis - CKS - NICE", "detail": "cks.nice.org.uk", "url": "https://cks.nice.org.uk/topics/headache-assessment/diagnosis/headache-diagnosis", "authors": "cks.nice.org.uk", "host": "cks.nice.org.uk", "snippet": "Cluster headache · At least five attacks of severe or very severe unilateral orbital, supraorbital, and/or temporal pain lasting 15–180 minutes (untreated), and", "score": 0.4654124 }, { "number": 22, "title": "Headache and Facial Pain: Differential Diagnosis and ...", "detail": "www.jaci-inpractice.org", "url": "https://www.jaci-inpractice.org/article/S2213-2198(13)00148-7/abstract", "authors": "www.jaci-inpractice.org", "host": "www.jaci-inpractice.org", "snippet": "by JA Bernstein · 2013 · Cited by 31 — Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Red flags in patients presenting with headache:", "score": 0.46366343 }, { "number": 23, "title": "Headaches in over 12s: diagnosis and management", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg150/chapter/recommendations", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "##### Acute treatment\n\n###### 1.3.34\n\nDiscuss the need for neuroimaging for people with a first bout of cluster headache with a GP with a special interest in headache or a neurologist. \n\n###### 1.3.35\n\nOffer oxygen and/or a subcutaneous or nasal triptan for the acute treatment of cluster headache. I", "score": 0.44420364 }, { "number": 24, "title": "Clinical features | Diagnosis | Headache - cluster - CKS - NICE", "detail": "cks.nice.org.uk", "url": "https://cks.nice.org.uk/topics/headache-cluster/diagnosis/clinical-features", "authors": "cks.nice.org.uk", "host": "cks.nice.org.uk", "snippet": "What are the typical clinical features of cluster headache? · Conjunctival injection and/or lacrimation. · Nasal congestion and/or rhinorrhoea. · Eyelid swelling.", "score": 0.43669468 } ], "publishedAt": "2026-08-24T16:31:17.315407+00:00", "updatedAt": "2026-08-24T16:31:17.315407+00:00", "readingMinutes": 5, "slug": "cluster-headache" }