Treatments to abort cluster headaches

When an attack starts, you have minutes before the pain peaks. Abortive treatments act fast to stop an attack early on. This page is an overview of the most effective abortive treatments.

A few rules apply across all of them:

• Take the treatment as soon as you feel an attack starting, not when the pain peaks.
• Don't take opioids: they don't help cluster headache and can make the underlying course worse.
• Most over-the-counter painkillers won't work.
• Pills in particular won't work, since they take too long to be absorbed.

Each treatment section below follows the same structure: a brief description, then Protocol (how to use it), Evidence (what the data show), and Side effects and considerations (what to watch for, plus practical issues like cost or access).

---

Summary of abortive treatments for cluster headaches

Treatment	Onset	Response	Evidence	Main barrier
High-flow oxygen (≥15 L/min, 25+ preferred)	5-15 min	78% relief at 15 min	RCT (strong)	Access
Sumatriptan injection	5-15 min	75% relief at 15 min	RCT (strong)	Monthly quantity limits
Zolmitriptan nasal 5/10 mg	10-30 min	50-63% relief at 30 min	RCT (strong)	Cost; 2 sprays/day max
Sumatriptan nasal 20 mg	15-30 min	57% relief at 30 min	RCT (strong)	Cost; 2 sprays/day max
DMT (vaped)	Seconds	Dramatic relief widely reported	One published case + community testimony; no RCT yet	Illegality
DHE (IV)	Under 15 min	~84% during admission	Open-label	Requires hospital
Intranasal lidocaine	5-15 min	25-55% partial relief	Small trials	Best as add-on
nVNS (gammaCore)	5-15 min	34-48% (episodic only)	RCT (strong)	Doesn't work for chronic CH
Octreotide injection (100 µg SC)	15-30 min	~52% relief at 30 min	RCT (small)	Niche; access
Ketamine (intranasal or IV)	10-30 min	~59% response at 30 min (intranasal pilot)	Small open-label	Limited access; abuse potential

---

High-flow oxygen

High-flow oxygen is the standard of care worldwide. It acts fast, has virtually no side effects, and is the safest abortive available. It works for nearly 80% of patients.

Our dedicated oxygen guide covers all the details: the correct breathing technique (with illustrations and videos), the equipment you need, how to navigate insurance, and the welding oxygen workaround, among others.

Protocol

It is crucial to get both the breathing technique and the equipment right. Many patients think oxygen doesn't work for them, when in reality they didn't use the proper technique, or their equipment wasn't adequate.

The basic idea is to breathe 100% high-flow oxygen as soon as you notice an attack starting, and until the pain stops. The technique involves inhaling as deeply as your lungs will allow, and then exhaling completely, forcefully pushing as much air out as you can. You then repeat this deep-inhale-and-exhale cycle as fast as you can. Most patients feel relief within five to fifteen minutes. Stay on the oxygen for a few extra minutes after the pain has fully stopped, since stopping the moment the attack ends sometimes lets it return. Learn more about the technique here.

Patients often breathe through a mask with a reservoir bag (called a "non-rebreather mask"). Alternatively, one can use a demand valve, which releases oxygen on demand as fast as you can breathe, which is usually even faster and more effective than a reservoir-bag mask.

The oxygen flow rate should be at least 15 liters per minute, with 25 L/min or higher strongly preferred. A lower flow, or using a nasal cannula, will not work.

Evidence

The evidence base is substantial and consistent. The landmark double-blind randomized trial found 78% of attacks were pain-free or had adequate relief at 15 minutes with oxygen.^[1] Multiple earlier and later studies replicate the effect. Every major guideline rates oxygen at its highest evidence level and recommends it as a first-line abortive: the European Academy of Neurology 2023 guidelines,^[2] the American Headache Society 2016 guidelines,^[3] and NICE CG150 in the UK.^[4] Given the safety profile, current expert reviews argue that every patient with cluster headache (or suspected to have it) must be allowed to try oxygen.^[5]

Side effects and considerations

Oxygen has no notable side effects, no drug interactions, and no dosing ceiling. The main issue is access. In the US, Medicare doesn't reliably cover home oxygen for cluster headache, and many suppliers refuse to fill the prescription. A patient survey of more than 2,000 people found only 49% had access to oxygen, despite it being the safest and most effective abortive.^[6] About 44% of patients had to suggest it to their doctor themselves; 12% of doctors refused outright. However, patients can secure their own oxygen privately (read our welding oxygen guide to learn how).

---

Sumatriptan injection

Sumatriptan is a fast pharmacological abortive. It belongs to a class of drugs called "triptans" (the same class used for migraine), and the injectable form is considered the most effective at aborting cluster headache attacks.

Protocol

A standard sumatriptan dose is 6 mg, given as an injection just under the skin (subcutaneous) using an autoinjector pen. It works in five to ten minutes. The recommended maximum is two injections (12 mg in total) in any 24-hour period.

Insurance plans typically limit supply to four to eight injections a month, which is well below what many cluster patients need. A widely used community workaround is to split each 6 mg dose into two or three smaller doses (around 2–3 mg per shot) using an insulin syringe. The basic idea is to ask your doctor to prescribe sumatriptan as a vial (or as the kit with a separate cartridge) instead of the prefilled autoinjector pen, and then use a small U-100 insulin syringe to draw smaller doses. You can then inject the smaller dose just under the skin of the thigh or belly.

The technique of splitting the larger sumatriptan dose into smaller doses has been popularized in the cluster headache community by Bob Wold's Pocket Guide to Cluster Headaches.

Evidence

Subcutaneous sumatriptan is the most-studied pharmacological abortive for cluster headache, with Level A evidence from multiple randomized controlled trials. A Cochrane meta-analysis found about 75% of attacks get relief at 15 minutes, with about half pain-free.^[7] Every major guideline recommends subcutaneous sumatriptan as a first-line abortive alongside oxygen.

Additionally, clinical trials support the practice of splitting into smaller doses. In one study, 89% of patients responded to a 2 mg injection and 74% to a 3 mg injection, with fewer side effects than at 6 mg.^[8] Keep in mind that the smaller-dose vials aren't sold commercially, so splitting is off-label and not endorsed by manufacturers.

Side effects and considerations

Sumatriptan shouldn't be used if you have heart disease, uncontrolled high blood pressure, or are pregnant. It also can't be combined with ergot drugs (such as DHE, below) within 24 hours.

The patient community has one important caveat. With frequent use over time, many patients report that attacks become more frequent and more intense. A small case series found the same pattern.^[9] This doesn't apply to occasional use, but it's worth watching if you're injecting daily for weeks. It is therefore recommended to try oxygen first (or other abortives that are not triptans), and to use sumatriptan only when necessary.

---

Triptan nasal sprays (zolmitriptan and sumatriptan)

Both zolmitriptan and sumatriptan come as nasal sprays. They're slower than the sumatriptan injection and less effective overall, but they're useful backups when an injection isn't available, isn't tolerated, or when you've already hit your daily injection limit. Zolmitriptan tends to be a bit faster and more effective; sumatriptan tends to be cheaper.

Protocol

Use it at the very first sign of an attack, the same rule as for the injection.

To use it, sit upright, place the tip just inside one nostril, breathe gently through your nose as you press the spray, and don't sniff hard. The medication needs to coat the lining at the back of your nose, not run down your throat.

• Zolmitriptan nasal spray: 5 mg per dose, with 10 mg used for severe attacks. Onset is about 10 to 30 minutes. Maximum 10 mg in any 24-hour period.
• Sumatriptan nasal spray: 20 mg per dose, into one nostril. Onset is about 15 to 30 minutes. Maximum 40 mg in any 24-hour period.

Both come as single-use sprayers (one dose per sprayer), typically sold in packs of six. Because of the 24-hour maximums above, two sprays a day is the most the label allows: a single pack covers roughly three days of maximum use. If you have several attacks a day, you'll hit the daily ceiling on the second attack and need a different abortive (oxygen, an injection) for the rest of the day.

Evidence

Both have Level A evidence from randomized trials:

• Zolmitriptan: At 30 minutes, 50% of attacks get relief with 5 mg and 63% with 10 mg, compared to roughly 25% with placebo.^[10][11] The 10 mg dose works noticeably better for episodic cluster headache (74% relief) than chronic (41%).
• Sumatriptan: About 57% of attacks get relief at 30 minutes, compared to 26% with placebo.^[12]

EAN 2023 and AHS 2016 recommend both as alternatives when injectable sumatriptan isn't suitable.

Side effects and considerations

The same cautions as sumatriptan injections apply (no heart disease, no ergots within 24 hours, not in pregnancy). In most countries, zolmitriptan nasal spray is approved for migraine and used off-label for cluster headache.

Cost is a real consideration and varies widely by country, brand, and how you pay. In the US, generic sumatriptan 20 mg nasal spray retails around $175 per 6-spray pack but drops to roughly $30–50 per pack with discount cards. Generic zolmitriptan 5 mg nasal spray is harder to find and more expensive, often $200 or more per 6-spray pack even with discounts. Patients with frequent attacks might end up needing many packs, since each pack only lasts about three days (given the 24-hour dose ceilings mentioned earlier).

---

DMT

DMT (N,N-dimethyltryptamine) is a short-acting psychedelic that is chemically very similar to sumatriptan (but it is not a triptan). Vaped at a small dose, DMT can stop a cluster attack within seconds and without psychedelic effects, and the substance clears your system in about 15 minutes. Patient reports describe relief that's sharper and faster than any other abortive.

Our dedicated DMT guide covers all the details: the protocol, equipment, what the experience feels like, drug interactions, and safety.

Protocol

The aborting dose is very small: most patients use roughly 3 to 5 mg of DMT per attack, vaped through a DMT-compatible vape pen. The recommended approach is small-puff titration: at the first sign of an attack, take one short inhalation, hold the vapor in your lungs for a few seconds, then exhale. Wait about 30 seconds. If the pain is not gone, take another puff and repeat until the attack ends, or until the effects feel like enough.

Make sure to sit or lie down somewhere safe before dosing. While the effects are usually short and mild, one should not drive or operate anything for at least 30 minutes after dosing.

For a detailed description of the protocols, see our DMT guide.

Evidence

DMT has no completed clinical trials in cluster headache yet, and no published study has quantified how often it works. Published evidence so far amounts to a single case: in a Swedish survey of 314 patients, one participant who used DMT reported a fully abortive effect on attacks.^[13] A formal patient survey conducted by Dr. Emmanuelle Schindler at Yale is ongoing.

The patient-reported evidence is much larger and striking, even if it hasn't been formally quantified. Across patient forums and advocacy networks, patients consistently describe dramatic relief: pain dropping from 10/10 to near zero within seconds of a small puff, on doses that don't produce a full psychedelic experience. The closely related psychedelics psilocybin and LSD have stronger published evidence in cluster headache, though primarily as preventives rather than abortives.^[14][15] No clinical guideline currently covers DMT for cluster headache.

Side effects and considerations

At the small doses used to abort cluster attacks, DMT is very safe. Cardiovascular and psychological risks are minimal, side effects are mild (anxiety is the most reported, which goes away once the effect wears off), and there's no tolerance buildup or rebound.

The main concern is drug interactions. DMT must not be combined with lithium (seizure risk), and care is needed with SSRIs, SNRIs, MAOIs, and triptans, all of which can raise the risk of serotonin syndrome or cardiovascular strain when taken with DMT. Our DMT safety chapter has the full interaction table and a serotonin-syndrome primer; read it before starting.

The other practical consideration is legality. DMT is illegal in most countries, though enforcement varies.

DMT is also very easy to extract at home. See our extraction guide for more details.

---

Dihydroergotamine (DHE)

DHE belongs to the ergot family, a class of chemicals originally derived from a fungus that grows on rye. It was synthesized in 1943, decades before the triptans, and remained a mainstay of headache treatment until sumatriptan arrived in the early 1990s. It narrows the blood vessels around the brain in a way similar to a triptan, but its effect lasts much longer. A single dose can suppress attacks for many hours or even most of a day, rather than just stopping the one in front of you.

For that reason, DHE plays two distinct roles in cluster headache:

1. As a self-administered acute treatment, it's a second-line option for patients who don't tolerate triptans or who want longer cover between attacks.
2. As a multi-day intravenous (IV) course in a hospital, it's used to break a long or refractory bout when nothing else has worked.

Protocol

DHE comes in three forms, each used in a different situation. Across all three, you must not have used a triptan in the previous 24 hours (see Side effects below).

1. IV (intravenous), in hospital, to break a stubborn cycle. Given as part of a three- to five-day admission, often called the Raskin protocol: 0.5 to 1 mg IV every eight hours, with metoclopramide (an anti-nausea drug) alongside to prevent the nausea DHE often causes. This is reserved for severe or treatment-refractory bouts. Your neurologist or a headache specialist will arrange it.

2. Self-injection (intramuscular or subcutaneous), at home, for individual attacks. A 1 mg dose injected into the muscle or just under the skin at the start of an attack. Until 2025 this required drawing the drug from a vial into a syringe yourself. A new autoinjector pen (Brekiya, FDA-approved May 2025) is the first DHE specifically labeled for cluster headache, and works much like a sumatriptan autoinjector.

3. Nasal spray (Migranal, Trudhesa), at home, when injection isn't an option. One spray (0.5 mg for Migranal, 0.725 mg for Trudhesa) into each nostril at the start of an attack, repeated after 15 minutes if needed. Slower and weaker than the injectable forms, but easier to use and the only DHE option many patients can self-administer without needles.

Evidence

Formal trial evidence for DHE in acute cluster headache is surprisingly thin. The only randomized controlled trial is a small 1986 study of 25 patients using nasal DHE at 1 mg per attack: it cut attack intensity significantly but didn't change frequency or duration, and the authors themselves suspected the dose was too low.^[16] Modern reviews are blunt about this: DHE is "sometimes used in clinical practice" but "has not been proven as an effective abortive therapy" by current trial standards.^[5]

The stronger evidence is for the IV inpatient protocol in refractory patients. An open-label series of 97 patients reported 63% complete pain resolution at one month after a short admission,^[17] and other inpatient series consistently report around 84% becoming attack-free during the admission itself. EAN 2023 gives intranasal DHE a weak recommendation; the AHS 2016 guideline lists DHE among second-line options.

Side effects and considerations

DHE cannot be combined with triptans within 24 hours: both constrict blood vessels by similar mechanisms, and stacking them can be dangerous. It also shouldn't be used if you have coronary artery disease, peripheral vascular disease (poor circulation in the limbs), uncontrolled high blood pressure, liver or kidney problems, or if you're pregnant. Nausea is the most common side effect across all forms.

Access is the other practical hurdle. IV DHE requires a hospital admission or infusion center. The injectable and nasal forms have become unexpectedly expensive even as generics (Trudhesa lists at around $900 a pack), and many insurers deny coverage as off-label for cluster headache. Some pharmacies don't carry it at all. Many neurologists are unfamiliar with prescribing it, so you may need to ask a headache specialist.

---

Intranasal lidocaine

Lidocaine is the same local anesthetic dentists use to numb your gums. The reason it can help cluster headache is anatomical: a small bundle of nerves called the sphenopalatine ganglion sits behind the nasal cavity and plays a central role in driving an attack. Coating those nerves with lidocaine briefly silences them.

It's a low-cost, low-risk add-on. On its own it usually provides only partial relief; alongside oxygen or a triptan, it can shave more pain off an attack and sometimes help you fall back asleep afterwards.

Protocol

You need a prescription. The right form is a 4% lidocaine solution in a dropper bottle (a 10% version exists but has to be compounded). Sprays don't work well for cluster headache: the goal is to bathe the nerve at the back of the nasal cavity, not to mist the front of your nose. The technique matters more than the dose.

A widely used patient-community technique (described in Bob Wold's Pocket Guide to Cluster Headaches):

1. Lie on your back across the edge of a bed so your head hangs over the edge, tilted backward and downward.
2. Turn your head about 30 degrees toward the painful side.
3. Drop a full eyedropper of 4% lidocaine into the nostril on the painful side.
4. Stay in that position for two or three minutes so the liquid reaches the back of the nasal cavity and pools over the sphenopalatine ganglion.

A bitter taste at the back of your throat is a sign the lidocaine is reaching the right place.

Evidence

The evidence base is small but consistent. In an open-label study of 30 patients, about a quarter got moderate relief, another quarter mild relief, and nearly half got nothing.^[18] A small double-blind randomized trial (n=15) using 10% lidocaine on a cotton swab applied to the sphenopalatine fossa for five minutes significantly shortened attacks.^[19] A modern review notes that exact dosing and best method of administration remain uncertain, but that lidocaine has no significant adverse effects and "remains a viable option for some patients."^[5] EAN 2023 gives it a weak recommendation as an add-on to oxygen or triptans.

Side effects and considerations

Side effects are minimal: a bitter taste, brief throat numbness, occasionally a small nosebleed. There are no meaningful drug interactions at these doses. The 4% solution is inexpensive almost everywhere; the 10% version requires a compounding pharmacy and is harder to get.

Don't rely on lidocaine as your only abortive. The response rate is modest, and most patients who use it do so alongside oxygen or a triptan rather than in place of them.

---

Non-invasive vagus nerve stimulation (gammaCore)

gammaCore is a small handheld device, about the size of a TV remote, that delivers a mild electrical stimulation to the vagus nerve through the skin of your neck. The vagus is a major nerve that runs from the brainstem down the side of the neck and into the chest and abdomen. Stimulating it appears to dampen the brain pathways that drive a cluster attack, without anything entering the body and without any drug.

One important caveat is that gammaCore only works for episodic cluster headache. Both of the large trials behind it failed when patients with chronic CH were included, and every guideline reflects this.

Protocol

The device has two stainless-steel contact pads on one end. You smear conductive gel onto the pads, press them against the side of your neck over the carotid artery (the spot where you can feel your pulse), and start a 2-minute stimulation. You'll feel a vibrating, tingling sensation; the corner of your mouth on that side may pull slightly during the stimulation, which is harmless and expected.

At the first sign of an attack:

1. Apply gel and place the device on one side of your neck.
2. Run one 2-minute stimulation.
3. Immediately repeat for another 2 minutes on the same side (not the opposite side).
4. If the attack hasn't resolved after 15 minutes, the manufacturer allows a second pair of stimulations.

Many patients also use gammaCore preventively, typically three pairs of stimulations a day on a fixed schedule. The FDA has cleared the device for both acute and preventive treatment of episodic cluster headache.

The device is locked: a monthly authorization code, supplied through your pharmacy or prescriber, unlocks a fixed number of stimulations. When the month ends, you renew the code.

Evidence

Two large randomized trials support gammaCore for episodic cluster headache. Both compared the real device against a dummy device that looked and felt similar but delivered no actual stimulation (a placebo). In the first trial, 34.2% of attacks treated with the real device responded at 15 minutes, versus 10.6% with the dummy device.^[20] In the second trial, 47.5% of real-device attacks were pain-free at 15 minutes, versus 6.2% with the dummy device.^[21] Both trials were negative when episodic and chronic patients were pooled: the entire benefit came from the episodic subgroup.

EAN 2023 gives a strong recommendation for episodic CH only, and AHS 2016 lists it among second-line acute options.

Side effects and considerations

Side effects are mild and transient: tingling or buzzing at the application site, brief twitching of the corner of the mouth, a metallic taste, sometimes a slight hoarseness during stimulation. There are no drug interactions to worry about.

Don't use gammaCore if you have an implanted electronic device in your head, neck, or chest (such as a pacemaker, vagus nerve stimulator, or deep brain stimulator), a metallic implant in the neck (such as a carotid stent), or significant carotid artery disease. Check with your doctor if you have a cardiac arrhythmia or a history of fainting.

The main practical hurdle is cost. The monthly authorization code is essentially a recurring prescription, so the device cannot be used as a one-time purchase. In the UK, the NHS covers gammaCore. In the US, insurance coverage is patchy, and out-of-pocket cost is typically $600 or more per month.

---

Octreotide

Octreotide is a synthetic version of somatostatin, a hormone that dampens the release of several signaling molecules in the trigeminal nerve system, including CGRP. It comes as a subcutaneous injection. It is rarely a first choice, but it has a real place when triptans are contraindicated, since it doesn't constrict blood vessels and is safe in patients with heart disease.

Protocol

A standard dose is 100 µg injected just under the skin at the first sign of an attack, using a small syringe similar to a sumatriptan vial. Most patients feel relief within 15 to 30 minutes. The dose can be repeated for a later attack, but a single dose per attack is the norm.

Evidence

A small placebo-controlled trial in 57 patients found that 52% of attacks treated with octreotide had complete relief at 30 minutes, compared to 36% with placebo.^[22] A 2022 meta-analysis of acute cluster headache treatments ranked octreotide fourth overall, after oxygen, subcutaneous sumatriptan, and nVNS, and ahead of intranasal zolmitriptan.^[23] EAN 2023 gives octreotide a weak recommendation as an alternative when triptans can't be used.

Side effects and considerations

The most common side effects are gastrointestinal: nausea, abdominal cramping, and loose stools. Occasionally octreotide raises blood sugar, which matters if you have diabetes. Injection-site reactions are mild.

Octreotide does not narrow blood vessels, which is why it is the preferred parenteral abortive for patients with coronary artery disease, uncontrolled high blood pressure, or other conditions that rule out triptans and DHE. It has no meaningful interactions with other cluster headache medications.

The main practical hurdle is access. Octreotide is approved for hormone-secreting tumors and a few other conditions, not for cluster headache, so a cluster prescription is off-label. It is rarely stocked by community pharmacies and can be expensive without insurance coverage.

---

Ketamine

Ketamine is an anesthetic and N-methyl-D-aspartate (NMDA) receptor blocker that has been used for decades in surgery and emergency medicine. It is now being studied for severe headache disorders. Two routes have been tested for cluster headache attacks: an intranasal spray that patients can use at home, and an intravenous infusion given in a clinic or hospital. Both are still experimental for cluster headache and are not in any treatment guideline.

Protocol

Intranasal ketamine has been tested in an open-label pilot study using 15 mg sprayed into the nose, repeated every six minutes for up to five doses, until the attack stops.^[24] Patients self-administered at the start of an attack.

Intravenous ketamine is given in a clinic, typically as 0.5 mg/kg over 30 to 60 minutes, sometimes combined with magnesium sulfate (another NMDA-related drug). Effects on individual attacks can last well beyond the infusion itself: case series describe weeks to months of reduced attack frequency after a single course, which is why some clinicians consider IV ketamine more of a transitional than a purely abortive treatment (see bridge chapter).

Evidence

In the intranasal pilot study of chronic cluster headache patients, 59% had at least a 50% reduction in attack pain within 30 minutes.^[24] The study had no placebo arm.

Three small case series of IV ketamine have reported that nearly all attacks in episodic patients are aborted during the infusion, and that the majority of chronic patients see at least a 50% drop in attack frequency or intensity afterward, with benefit lasting weeks to as long as 18 months.^[25][26][27] All were open-label.

Side effects and considerations

At the doses used here, side effects are typically brief: dissociation (a feeling of detachment from your body), dizziness, blurred vision, nausea, and a temporary rise in blood pressure or heart rate. Most patients feel back to normal within 30 to 60 minutes.

The bigger concerns are practical. Ketamine has abuse potential and is a controlled substance in most countries, which limits prescribing. The intranasal preparation has to be compounded; commercial intranasal ketamine sprays (such as esketamine) are licensed for depression, not cluster headache, and prices are very high. IV ketamine requires a clinic or hospital setting with monitoring. For both reasons, ketamine is currently only available through specialist headache or pain clinics that have set up a protocol.

---

References

1. ↩ Cohen AS, Burns B, Goadsby PJ (2009). High-flow oxygen for treatment of cluster headache: a randomized trial. JAMA, 302(22), 2451–2457. Link
2. ↩ May A, Evers S, Goadsby PJ, Leone M, Manzoni GC, Pascual J, et al. (2023). European Academy of Neurology guidelines on the treatment of cluster headache. European Journal of Neurology, 30(10), 2955–2979. doi:10.1111/ene.15956
3. ↩ Robbins MS, Starling AJ, Pringsheim TM, Becker WJ, Schwedt TJ (2016). Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache, 56(7), 1093–1106. doi:10.1111/head.12866
4. ↩ National Institute for Health and Care Excellence (2021). Headaches in over 12s: diagnosis and management (CG150). NICE Clinical Guideline. Link
5. ↩ Kingston WS, Dodick DW (2018). Treatment of cluster headache. Annals of Indian Academy of Neurology, 21(Suppl 1), S9–S15. Link
6. ↩ Schor LI, Pearson SM, Shapiro RE, Zhang W, Miao H, Burish MJ (2021). Cluster headache epidemiology including pediatric onset, sex, and ICHD criteria: Results from the International Cluster Headache Questionnaire. Headache, 61(10), 1511–1520. Link
7. ↩ Law S, Derry S, Moore RA (2013). Triptans for acute cluster headache. Cochrane Database of Systematic Reviews(7), CD008042. Link
8. ↩ Gross WL, Lavender D, Schmidt-Wilcke T, et al. (2005). Treatment of cluster headache attacks with less than 6 mg subcutaneous sumatriptan. Headache, 45(8), 1069–1072. Link
9. ↩ Rossi P, Di Lorenzo G, Formisano R, Buzzi MG (2004). Sub-cutaneous sumatriptan induces changes in frequency pattern in cluster headache patients. Headache. Link
10. ↩ Cittadini E, May A, Straube A, Evers S, Bussone G, Goadsby PJ (2006). Effectiveness of intranasal zolmitriptan in acute cluster headache: a randomized, placebo-controlled, double-blind crossover study. Archives of Neurology, 63(11), 1537–1542. Link
11. ↩ Rapoport AM, Mathew NT, Silberstein SD, et al. (2007). Zolmitriptan nasal spray in the acute treatment of cluster headache: a double-blind study. Neurology, 69(9), 821–826. Link
12. ↩ van Vliet JA, Bahra A, Martin V, et al. (2003). Intranasal sumatriptan in cluster headache: randomized placebo-controlled double-blind study. Neurology, 60(4), 630–633. Link
13. ↩ Smedfors G, Liljenberg T, Steinberg A (2024). Use of prescribed and non-prescribed treatments for cluster headache in a Swedish cohort. Cephalalgia.
14. ↩ Sewell RA, Halpern JH, Pope HG Jr (2006). Response of cluster headache to psilocybin and LSD. Neurology, 66(12), 1920–1922. doi:10.1212/01.wnl.0000219761.05466.43
15. ↩ Schindler EAD, Sewell RA, Gottschalk CH, Flynn LT, Zhu Y, Pittman BP, et al. (2024). Psilocybin pulse regimen reduces cluster headache attack frequency in the blinded extension phase of a randomized controlled trial. Journal of the Neurological Sciences, 460, 122993. doi:10.1016/j.jns.2024.122993
16. ↩ Andersson PG, Jespersen LT (1986). Dihydroergotamine nasal spray in the treatment of attacks of cluster headache: a double-blind trial versus placebo. Cephalalgia, 6(1), 51–54. doi:10.1046/j.1468-2982.1986.0601051.x
17. ↩ Magnoux E, Zlotnik G (2004). Outpatient intravenous dihydroergotamine for refractory cluster headache. Headache, 44(3), 249–255. Link
18. ↩ Robbins L (1995). Intranasal lidocaine for cluster headache. Headache, 35(2), 83–84. Link
19. ↩ Costa A, Pucci E, Antonaci F, et al. (2000). The effect of intranasal cocaine and lidocaine on nitroglycerin-induced attacks in cluster headache. Cephalalgia, 20(2), 85–91. Link
20. ↩ Silberstein SD, Mechtler LL, Kudrow DB, et al. (2016). Non-invasive vagus nerve stimulation for the acute treatment of cluster headache: findings from the randomized, double-blind, sham-controlled ACT1 study. Headache, 56(8), 1317–1332. Link
21. ↩ Goadsby PJ, de Coo IF, Silver N, et al. (2018). Non-invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: a randomized, double-blind, sham-controlled ACT2 study. Cephalalgia, 38(5), 959–969. Link
22. ↩ Matharu MS, Levy MJ, Meeran K, Goadsby PJ (2004). Subcutaneous octreotide in cluster headache: randomized placebo-controlled double-blind crossover study. Annals of Neurology, 56(4), 488–494. Link
23. ↩ Medrea I, Christie S, Tepper SJ, Thavorn K, Hutton B (2022). Network meta-analysis of therapies for cluster headache: effects of acute therapies for episodic and chronic cluster. Headache. doi:10.1111/head.14283
24. ↩ Petersen AS, Pedersen AS, Barloese MCJ, et al. (2022). Intranasal ketamine for acute cluster headache attacks: results from a proof-of-concept open-label trial. Headache, 62(1), 26–35. Link
25. ↩ Granata L, Niebergall H, Langner R, Agosti R, Sakellaris L (2016). Ketamin i.v. zur Behandlung von Clusterkopfschmerz: eine Beobachtungsstudie. Der Schmerz, 30(3), 286–288. Link
26. ↩ Moisset X, Clavelou P, Lauxerois M, Dallel R, Picard P (2017). Ketamine infusion combined with magnesium as a therapy for intractable chronic cluster headache: report of two cases. Headache, 57, 1261–1264. Link
27. ↩ Moisset X, Giraud P, Meunier E, et al. (2020). Ketamine-magnesium for refractory chronic cluster headache: a case series. Headache, 60, 2537–2543. Link